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Sample records for routine primary care

  1. Utilization of Routine Primary Care Services Among Dancers.

    PubMed

    Alimena, Stephanie; Air, Mary E; Gribbin, Caitlin; Manejias, Elizabeth

    2016-01-01

    This study examines the current utilization of primary and preventive health care services among dancers in order to assess their self-reported primary care needs. Participants were 37 dancers from a variety of dance backgrounds who presented for a free dancer health screening in a large US metropolitan area (30 females, 7 males; mean age: 27.5 ± 7.4 years; age range: 19 to 49 years; mean years of professional dancing: 6.4 ± 5.4 years). Dancers were screened for use of primary care, mental health, and women's health resources using the Health Screen for Professional Dancers developed by the Task Force on Dancer Health. Most dancers had health insurance (62.2%), but within the last 2 years, only approximately half of them (54.1%) reported having a physical examination by a physician. Within the last year, 54.1% of dancers had had a dental check-up, and 56.7% of female dancers received gynecologic care. Thirty percent of female participants indicated irregular menstrual cycles, 16.7% had never been to a gynecologist, and 16.7% were taking birth control. Utilization of calcium and vitamin D supplementation was 27.0% and 29.7%, respectively, and 73.0% were interested in nutritional counseling. A high rate of psychological fatigue and sleep deprivation was found (35.1%), along with a concomitant high rate of self-reported need for mental health counseling (29.7%). Cigarette and recreational drug use was low (5.4% and 5.4%); however, 32.4% engaged in binge drinking within the last year (based on the CDC definition). These findings indicate that dancers infrequently access primary care services, despite high self-reported need for nutritional, mental, and menstrual health counseling and treatment. More studies are warranted to understand dancers' primary health care seeking behavior. PMID:27661621

  2. Tobacco Use Patterns and Attitudes among Teens Being Seen for Routine Primary Care.

    ERIC Educational Resources Information Center

    Hollis, Jack F.; Polen, Michael R.; Lichtenstein, Edward; Whitlock, Evelyn P.

    2003-01-01

    Investigated the tobacco-related attitudes, behaviors, and needs of smoking and nonsmoking teens being seen for routine primary care, identifying tobacco use predictors. Most teens approached were willing to receive tobacco and diet interventions. Smoking predictors included older age, lower educational aspirations, having parents or friends who…

  3. Transitioning to routine breast cancer risk assessment and management in primary care: what can we learn from cardiovascular disease?

    PubMed

    Phillips, Kelly-Anne; Steel, Emma J; Collins, Ian; Emery, Jon; Pirotta, Marie; Mann, G Bruce; Butow, Phyllis; Hopper, John L; Trainer, Alison; Moreton, Jane; Antoniou, Antonis C; Cuzick, Jack; Keogh, Louise

    2016-01-01

    To capitalise on advances in breast cancer prevention, all women would need to have their breast cancer risk formally assessed. With ~85% of Australians attending primary care clinics at least once a year, primary care is an opportune location for formal breast cancer risk assessment and management. This study assessed the current practice and needs of primary care clinicians regarding assessment and management of breast cancer risk. Two facilitated focus group discussions were held with 17 primary care clinicians (12 GPs and 5 practice nurses (PNs)) as part of a larger needs assessment. Primary care clinicians viewed assessment and management of cardiovascular risk as an intrinsic, expected part of their role, often triggered by practice software prompts and facilitated by use of an online tool. Conversely, assessment of breast cancer risk was not routine and was generally patient- (not clinician-) initiated, and risk management (apart from routine screening) was considered outside the primary care domain. Clinicians suggested that routine assessment and management of breast cancer risk might be achieved if it were widely endorsed as within the remit of primary care and supported by an online risk-assessment and decision aid tool that was integrated into primary care software. This study identified several key issues that would need to be addressed to facilitate the transition to routine assessment and management of breast cancer risk in primary care, based largely on the model used for cardiovascular disease.

  4. Routine primary care management of acute low back pain: adherence to clinical guidelines.

    PubMed

    González-Urzelai, Violeta; Palacio-Elua, Loreto; López-de-Munain, Josefina

    2003-12-01

    One of the major challenges for general practitioners is to manage individuals with acute low back pain appropriately to reduce the risk of chronicity. A prospective study was designed to assess the actual management of acute low back pain in one primary care setting and to determine whether existing practice patterns conform to published guidelines. Twenty-four family physicians from public primary care centers of the Basque Health Service in Bizkaia, Basque Country (Spain), participated in the study. A total of 105 patients aged 18-65 years presenting with acute low back pain over a 6-month period were included. Immediately after consultation, a research assistant performed a structured clinical interview. The patients' care provided by the general practitioner was compared with the Agency for Health Care Policy and Research (AHCPR) guidelines and guidelines issued by the Royal College of General Practitioners. The diagnostic process showed a low rate of appropriate use of history (27%), physical examination (32%), lumbar radiographs (31%), and referral to specialized care (33%). Although the therapeutic process showed a relatively high rate of appropriateness in earlier mobilization (77%) and educational advice (65%), only 23% of patients were taught about the benign course of back pain. The study revealed that management of acute low back pain in the primary care setting is far from being in conformance with published clinical guidelines. PMID:14605973

  5. Routine follow up of breast cancer in primary care: randomised trial.

    PubMed Central

    Grunfeld, E.; Mant, D.; Yudkin, P.; Adewuyi-Dalton, R.; Cole, D.; Stewart, J.; Fitzpatrick, R.; Vessey, M.

    1996-01-01

    OBJECTIVE: To assess the effect on time to diagnosis of recurrence and on quality of life of transferring primary responsibility for follow up of women with breast cancer in remission from hospital to general practice. DESIGN: Randomised controlled trial with 18 month follow up in which women received routine follow up either in hospital or in general practice. SUBJECTS AND SETTING: 296 women with breast cancer in remission receiving regular follow up care at district general hospitals in England. MAIN OUTCOME MEASURES: Time between first presentation of symptoms to confirmation of recurrence; quality of life measured by specific dimensions of the SF-36 schedule, the EORTC symptom scale, and hospital anxiety and depression scale. RESULTS: Most recurrences (18/26, 69%) presented as interval events, and almost half (7/16, 44%) of the recurrences in the hospital group presented first to general practice. The median time to hospital confirmation of recurrence was 21 days in the hospital group (range 1-376 days) and 22 days in the general practice group (range 4-64). The differences between groups in the change in SF-36 mean scores from baseline were small: -1.8 (95% confidence interval -7.2 to 3.5) for social functioning, 0.5 (-4.1 to 5.1) for mental health, and 0.6 (-3.6 to 4.8) for general health perception. The change from baseline in the mean depression score was higher in the general practice group at the mid-trial assessment (difference 0.6, 0.1 to 1.2) but there was no significant difference between groups in the anxiety score or the EORTC scales. CONCLUSION: General practice follow up of women with breast cancer in remission is not associated with increase in time to diagnosis, increase in anxiety, or deterioration in health related quality of life. Most recurrences are detected by women as interval events and present to the general practitioner, irrespective of continuing hospital follow up. PMID:8811760

  6. Implementation of chronic illness care in German primary care practices – how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling

    PubMed Central

    2014-01-01

    Background In primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views. Methods This cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice). Results The overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice. Conclusions This study shows that from the perspective of multimorbid patients receiving care in German

  7. Routine checks for HIV in children attending primary health care facilities in South Africa: attitudes of nurses and child caregivers.

    PubMed

    Horwood, Christiane; Voce, Anna; Vermaak, Kerry; Rollins, Nigel; Qazi, Shamim

    2010-01-01

    Management of HIV-infected and exposed children is challenging for health workers in primary care settings. Integrated management of childhood illness (IMCI) is a WHO/UNICEF strategy for improving morbidity and mortality in under 5 children attending first level facilities in developing countries. In high HIV-prevalence settings, IMCI includes an HIV component for identification and management of HIV-infected and exposed children, which requires health workers to ask all mothers about their HIV status and check all children for signs of HIV. Effective implementation of the HIV component depends on the ability and willingness of health workers to take every opportunity to identify HIV-infected children during routine care, and implementation in South Africa is poor. In 2006, we conducted 10 focus groups in two provinces in South Africa with IMCI-trained nurses, and with mothers attending first level facilities, to determine their attitudes towards, and experiences of, routine checks for HIV during consultations with sick children. Nurses were frequently unwilling to check for HIV in all children, believing it was unnecessary, unacceptable to mothers, and that they lack skills to implement HIV care. Nurses feared mothers would become upset or make a complaint. Mothers consistently recognised the importance of checking children for HIV and supported implementation of routine checks, although the attitude of the nurse was important in determining the acceptability of HIV-related questions. Mothers expressed fears about lack of confidentiality from nurses, and that receiving HIV-related services could lead to unintentional disclosure of their HIV status. Nurses lack the skills in HIV management and communication skills to implement the HIV component of IMCI. We identify issues relate to improved training, clear policies on record keeping, and organization of health services to respect privacy and confidentiality, to improve the willingness of health workers to provide

  8. Atypical leg symptoms: does routine measurement of the ankle brachial pressure index (ABPI) in primary care benefit patients?

    PubMed Central

    Oesterling, Christine; Kalia, Amun; Chetcuti, Thomas; Walker, Steven

    2015-01-01

    Abstract Background: Managing patients with atypical leg symptoms in primary care can be problematic. Determining the ankle brachial pressure index (ABPI) may be readily performed to help diagnose peripheral arterial disease, but is often omitted where signs and symptoms are unclear. Question : Does routine measurement of ABPI in patients with atypical leg symptoms aid management increase satisfaction and safely reduce hospital referral? Methodology : Patients with atypical leg symptoms but no skin changes or neurological symptoms underwent clinical review and Doppler ABPI measurement (suspicious finding ≤ 1.0). Testing was performed by the same doctor (study period: 30 months). Patient outcomes were determined from practice records, hospital letters and a telephone survey. Results: The study comprised 35 consecutive patients (males: N = 15), mean age 64 years (range: 39–88). Presentation included pain, cold feet, cramps, irritation and concerns regarding circulation. Prior to ABPI measurement, referral was considered necessary in 10, not required in 22 and unclear in 3. ABPI changed the referral decision in 10 (29%) and confirmed the decision in 25 (71%). During the study, 10 (29%) patients were referred (9 vascular, 1 neurology). Amongst the vascular referrals, significant peripheral arterial disease has been confirmed in six patients. A further two patients are under review and one did not attend. To date, lack of referral in patients with atypical leg symptoms but a normal ABPI has not increased morbidity. Current status was assessed by telephone review in 16/35 (46% contact rate; mean 18 months, range 2–28). Fifteen patients (94%) appreciated that their symptoms had been quickly and conveniently assessed, 8/11 (73%) with a normal ABPI were reassured by their result and in 8/11 symptoms have resolved. Discussion/Conclusion : APBI conveniently aids management of atypical leg symptoms by detecting unexpected peripheral arterial disease, avoids

  9. The Impact of Polio Eradication on Routine Immunization and Primary Health Care: A Mixed-Methods Study

    PubMed Central

    Closser, Svea; Cox, Kelly; Parris, Thomas M.; Landis, R. Matthew; Justice, Judith; Gopinath, Ranjani; Maes, Kenneth; Banteyerga Amaha, Hailom; Mohammed, Ismaila Zango; Dukku, Aminu Mohammed; Omidian, Patricia A.; Varley, Emma; Tedoff, Pauley; Koon, Adam D.; Nyirazinyoye, Laetitia; Luck, Matthew A.; Pont, W. Frank; Neergheen, Vanessa; Rosenthal, Anat; Nsubuga, Peter; Thacker, Naveen; Jooma, Rashid; Nuttall, Elizabeth

    2014-01-01

    Background. After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC). Methods. Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review. Results. Our quantitative analysis did not find compelling evidence of widespread and significant effects of polio eradication campaigns, either positive or negative, on measures of RI and maternal healthcare. Our qualitative analysis revealed context-specific positive impacts of polio eradication activities in many of our case studies, particularly disease surveillance and cold chain strengthening. These impacts were dependent on the initiative of policy makers. Negative impacts, including service interruption and public dissatisfaction, were observed primarily in districts with many campaigns per year. Conclusions. Polio eradication activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts. PMID:24690667

  10. Costs, effects and implementation of routine data emergency admission risk prediction models in primary care for patients with, or at risk of, chronic conditions: a systematic review protocol

    PubMed Central

    Kingston, Mark Rhys; Evans, Bridie Angela; Nelson, Kayleigh; Hutchings, Hayley; Russell, Ian

    2016-01-01

    Introduction Emergency admission risk prediction models are increasingly used to identify patients, typically with one or more chronic conditions, for proactive management in primary care to avoid admissions, save costs and improve patient experience. Aim To identify and review the published evidence on the costs, effects and implementation of emergency admission risk prediction models in primary care for patients with, or at risk of, chronic conditions. Methods We shall search for studies of healthcare interventions using routine data-generated emergency admission risk models. We shall report: the effects on emergency admissions and health costs; clinician and patient views; and implementation findings. We shall search ASSIA, CINAHL, the Cochrane Library, HMIC, ISI Web of Science, MEDLINE and Scopus from 2005, review references in and citations of included articles, search key journals and contact experts. Study selection, data extraction and quality assessment will be performed by two independent reviewers. Ethics and dissemination No ethical permissions are required for this study using published data. Findings will be disseminated widely, including publication in a peer-reviewed journal and through conferences in primary and emergency care and chronic conditions. We judge our results will help a wide audience including primary care practitioners and commissioners, and policymakers. Trial registration number CRD42015016874; Pre-results. PMID:26932140

  11. The health informatics cohort enhancement project (HICE): using routinely collected primary care data to identify people with a lifetime diagnosis of psychotic disorder

    PubMed Central

    2012-01-01

    Background We have previously demonstrated that routinely collected primary care data can be used to identify potential participants for trials in depression [1]. Here we demonstrate how patients with psychotic disorders can be identified from primary care records for potential inclusion in a cohort study. We discuss the strengths and limitations of this approach; assess its potential value and report challenges encountered. Methods We designed an algorithm with which we searched for patients with a lifetime diagnosis of psychotic disorders within the Secure Anonymised Information Linkage (SAIL) database of routinely collected health data. The algorithm was validated against the "gold standard" of a well established operational criteria checklist for psychotic and affective illness (OPCRIT). Case notes of 100 patients from a community mental health team (CMHT) in Swansea were studied of whom 80 had matched GP records. Results The algorithm had favourable test characteristics, with a very good ability to detect patients with psychotic disorders (sensitivity > 0.7) and an excellent ability not to falsely identify patients with psychotic disorders (specificity > 0.9). Conclusions With certain limitations our algorithm can be used to search the general practice data and reliably identify patients with psychotic disorders. This may be useful in identifying candidates for potential inclusion in cohort studies. PMID:22333117

  12. Integrating evidence-based treatments for common mental disorders in routine primary care: feasibility and acceptability of the MANAS intervention in Goa, India

    PubMed Central

    CHATTERJEE, SUDIPTO; CHOWDHARY, NEERJA; PEDNEKAR, SULOCHANA; COHEN, ALEX; ANDREW, GRACY; ANDREW, GRACY; ARAYA, RICARDO; SIMON, GREGORY; KING, MICHAEL; TELLES, SHIRLEY; VERDELI, HELENA; CLOUGHERTY, KATHLEEN; KIRKWOOD, BETTY; PATEL, VIKRAM

    2008-01-01

    Common mental disorders, such as depression and anxiety, pose a major public health burden in developing countries. Although these disorders are thought to be best managed in primary care settings, there is a dearth of evidence about how this can be achieved in low resource settings. The MANAS project is an attempt to integrate an evidence based package of treatments into routine public and private primary care settings in Goa, India. Before initiating the trial, we carried out extensive preparatory work, over a period of 15 months, to examine the feasibility and acceptability of the planned intervention. This paper describes the systematic development and evaluation of the intervention through this preparatory phase. The preparatory stage, which was implemented in three phases, utilized quantitative and qualitative methods to inform our understanding of the potential problems and possible solutions in implementing the trial and led to critical modifications of the original intervention plan. Investing in systematic formative work prior to conducting expensive trials of the effectiveness of complex interventions is a useful exercise which potentially improves the likelihood of a positive result of such trials. PMID:18458786

  13. Integrating evidence-based treatments for common mental disorders in routine primary care: feasibility and acceptability of the MANAS intervention in Goa, India.

    PubMed

    Chatterjee, Sudipto; Chowdhary, Neerja; Pednekar, Sulochana; Cohen, Alex; Andrew, Gracy; Andrew, Gracy; Araya, Ricardo; Simon, Gregory; King, Michael; Telles, Shirley; Verdeli, Helena; Clougherty, Kathleen; Kirkwood, Betty; Patel, Vikram

    2008-02-01

    Common mental disorders, such as depression and anxiety, pose a major public health burden in developing countries. Although these disorders are thought to be best managed in primary care settings, there is a dearth of evidence about how this can be achieved in low resource settings. The MANAS project is an attempt to integrate an evidence based package of treatments into routine public and private primary care settings in Goa, India. Before initiating the trial, we carried out extensive preparatory work, over a period of 15 months, to examine the feasibility and acceptability of the planned intervention. This paper describes the systematic development and evaluation of the intervention through this preparatory phase. The preparatory stage, which was implemented in three phases, utilized quantitative and qualitative methods to inform our understanding of the potential problems and possible solutions in implementing the trial and led to critical modifications of the original intervention plan. Investing in systematic formative work prior to conducting expensive trials of the effectiveness of complex interventions is a useful exercise which potentially improves the likelihood of a positive result of such trials. PMID:18458786

  14. What is the relationship between renal function and visit-to-visit blood pressure variability in primary care? Retrospective cohort study from routinely collected healthcare data

    PubMed Central

    Lasserson, Daniel S; Scherpbier de Haan, Nynke; de Grauw, Wim; van der Wel, Mark; Wetzels, Jack F; O'Callaghan, Christopher A

    2016-01-01

    Objective To determine the relationship between renal function and visit-to-visit blood pressure (BP) variability in a cohort of primary care patients. Design Retrospective cohort study from routinely collected healthcare data. Setting Primary care in Nijmegen, the Netherlands, from 2007 to 2012. Participants 19 175 patients who had a measure of renal function, and 7 separate visits with BP readings in the primary care record. Outcome measures Visit-to-visit variability in systolic BP, calculated from the first 7 office measurements, including SD, successive variation, absolute real variation and metrics of variability shown to be independent of mean. Multiple linear regression was used to analyse the influence of estimated glomerular filtration rate (eGFR) on BP variability measures with adjustment for age, sex, diabetes, mean BP, proteinuria, cardiovascular disease, time interval between measures and antihypertensive use. Results In the patient cohort, 57% were women, mean (SD) age was 65.5 (12.3) years, mean (SD) eGFR was 75.6 (18.0) mL/min/1.73m2 and SD systolic BP 148.3 (21.4) mm Hg. All BP variability measures were negatively correlated with eGFR and positively correlated with age. However, multiple linear regressions demonstrated consistent, small magnitude negative relationships between eGFR and all measures of BP variability adjusting for confounding variables. Conclusions Worsening renal function is associated with small increases in measures of visit-to-visit BP variability after adjustment for confounding factors. This is seen across the spectrum of renal function in the population, and provides a mechanism whereby chronic kidney disease may raise the risk of cardiovascular events. PMID:27288374

  15. Routine Self-administered, Touch-Screen Computer Based Suicidal Ideation Assessment Linked to Automated Response Team Notification in an HIV Primary Care Setting

    PubMed Central

    Lawrence, Sarah T.; Willig, James H.; Crane, Heidi M.; Ye, Jiatao; Aban, Inmaculada; Lober, William; Nevin, Christa R.; Batey, D. Scott; Mugavero, Michael J.; McCullumsmith, Cheryl; Wright, Charles; Kitahata, Mari; Raper, James L.; Saag, Micheal S.; Schumacher, Joseph E.

    2010-01-01

    Summary The implementation of routine computer-based screening for suicidal ideation and other psychosocial domains through standardized patient reported outcome instruments in two high volume urban HIV clinics is described. Factors associated with an increased risk of self-reported suicidal ideation were determined. Background HIV/AIDS continues to be associated with an under-recognized risk for suicidal ideation, attempted as well as completed suicide. Suicidal ideation represents an important predictor for subsequent attempted and completed suicide. We sought to implement routine screening of suicidal ideation and associated conditions using computerized patient reported outcome (PRO) assessments. Methods Two geographically distinct academic HIV primary care clinics enrolled patients attending scheduled visits from 12/2005 to 2/2009. Touch-screen-based, computerized PRO assessments were implemented into routine clinical care. Substance abuse (ASSIST), alcohol consumption (AUDIT-C), depression (PHQ-9) and anxiety (PHQ-A) were assessed. The PHQ-9 assesses the frequency of suicidal ideation in the preceding two weeks. A response of “nearly every day” triggered an automated page to pre-determined clinic personnel who completed more detailed self-harm assessments. Results Overall 1,216 (UAB= 740; UW= 476) patients completed initial PRO assessment during the study period. Patients were white (53%; n=646), predominantly males (79%; n=959) with a mean age of 44 (± 10). Among surveyed patients, 170 (14%) endorsed some level of suicidal ideation, while 33 (3%) admitted suicidal ideation nearly every day. In multivariable analysis, suicidal ideation risk was lower with advancing age (OR=0.74 per 10 years;95%CI=0.58-0.96) and was increased with current substance abuse (OR=1.88;95%CI=1.03-3.44) and more severe depression (OR=3.91 moderate;95%CI=2.12-7.22; OR=25.55 severe;95%CI=12.73-51.30). Discussion Suicidal ideation was associated with current substance abuse and

  16. The Health Informatics Trial Enhancement Project (HITE): Using routinely collected primary care data to identify potential participants for a depression trial

    PubMed Central

    2010-01-01

    Background Recruitment to clinical trials can be challenging. We identified anonymous potential participants to an existing pragmatic randomised controlled depression trial to assess the feasibility of using routinely collected data to identify potential trial participants. We discuss the strengths and limitations of this approach, assess its potential value, report challenges and ethical issues encountered. Methods Swansea University's Health Information Research Unit's Secure Anonymised Information Linkage (SAIL) database of routinely collected health records was interrogated, using Structured Query Language (SQL). Read codes were used to create an algorithm of inclusion/exclusion criteria with which to identify suitable anonymous participants. Two independent clinicians rated the eligibility of the potential participants' identified. Inter-rater reliability was assessed using the kappa statistic and inter-class correlation. Results The study population (N = 37263) comprised all adults registered at five general practices in Swansea UK. Using the algorithm 867 anonymous potential participants were identified. The sensitivity and specificity results > 0.9 suggested a high degree of accuracy from the algorithm. The inter-rater reliability results indicated strong agreement between the confirming raters. The Intra Class Correlation Coefficient (Cronbach's Alpha) > 0.9, suggested excellent agreement and Kappa coefficient > 0.8; almost perfect agreement. Conclusions This proof of concept study showed that routinely collected primary care data can be used to identify potential participants for a pragmatic randomised controlled trial of folate augmentation of antidepressant therapy for the treatment of depression. Further work will be needed to assess generalisability to other conditions and settings and the inclusion of this approach to support Electronic Enhanced Recruitment (EER). PMID:20398303

  17. A Cost-Consequences analysis of the effect of Pregabalin in the treatment of peripheral Neuropathic Pain in routine medical practice in Primary Care settings

    PubMed Central

    2011-01-01

    Background Neuropathic pain (NeP) is a common symptom of a group of a variety of conditions, including diabetic neuropathy, trigeminal neuralgia, or postherpetic neuralgia. Prevalence of NeP has been estimated to range between 5-7.5%, and produces up to 25% of pain clinics consultations. Due to its severity, chronic evolution, and associated co-morbidities, NeP has an important individual and social impact. The objective was to analyze the effect of pregabalin (PGB) on pain alleviation and longitudinal health and non-health resources utilization and derived costs in peripheral refractory NeP in routine medical practice in primary care settings (PCS) in Spain. Methods Subjects from PCS were older than 18 years, with peripheral NeP (diabetic neuropathy, post-herpetic neuralgia or trigeminal neuralgia), refractory to at least one previous analgesic, and included in a prospective, real world, and 12-week two-visit cost-of-illness study. Measurement of resources utilization included both direct healthcare and indirect expenditures. Pain severity was measured by the Short Form-McGill Pain Questionnaire (SF-MPQ). Results One-thousand-three-hundred-fifty-four PGB-naive patients [58.8% women, 59.5 (12.7) years old] were found eligible for this secondary analysis: 598 (44%) switched from previous therapy to PGB given in monotherapy (PGBm), 589 (44%) received PGB as add-on therapy (PGB add-on), and 167 (12%) patients changed previous treatments to others different than PGB (non-PGB). Reductions of pain severity were higher in both PGBm and PGB add-on groups (54% and 51%, respectively) than in non-PGB group (34%), p < 0.001. Incremental drug costs, particularly in PGB subgroups [€34.6 (80.3), €160.7 (123.9) and €154.5 (133.0), for non-PGB, PGBm and PGBadd-on, respectively (p < 0.001)], were off-set by higher significant reductions in all other components of health costs yielding to a greater total cost reductions: -€1,045.3 (1,989.6),-€1,312.9 (1,543.0), and -€1

  18. Comparative estimated effectiveness of antibiotic classes as initial and secondary treatments of respiratory tract infections: longitudinal analysis of routine data from UK primary care 1991-2012.

    PubMed

    Berni, Ellen; Butler, Chris C; Jenkins-Jones, Sara; de Voogd, Hanka; Ouwens, Mario; Morgan, Christopher Ll; Currie, Craig J

    2016-06-01

    Purpose To compare the estimated effectiveness of seven frequently prescribed antibiotic classes as initial and secondary treatments of upper respiratory tract infections (URTIs) and lower respiratory tract infections (LRTIs) 1991-2012. The main outcome measure was a surrogate for estimated antibiotic effectiveness. Methods Routine, primary care data from the UK Clinical Practice Research Datalink (CPRD) were used. Having established standardized criteria representing antibiotic treatment failure, estimated treatment effectiveness rates were calculated as one minus the treatment failure rate. For each year from 1991 to 2012, estimated effectiveness rates by treatment line, indication, and sub-indication were calculated. These were presented by antibiotic class, with a sub-analysis for the macrolide clarithromycin. Findings From approximately 58 million antibiotic prescriptions in CPRD, we analyzed 8,654,734 courses of antibiotic monotherapy: 4,825,422 courses (56%) were associated with URTI; 3,829,312 (44%) were associated with LRTI. Amino-penicillins (4,148,729 [56%]), penicillins (1,304,561 [18%]), and macrolides (944,622 [13%]) predominated as initial treatments; macrolides (375,903 [32%]), aminopenicillins (275,866 [23%]), and cephalosporins (159,954 [14%]) as secondary treatments. Macrolides and aminopenicillins had estimated effectiveness rates ≥80% across the study period as initial treatments of URTI and LRTI. In secondary use, only macrolides maintained these rates: 80.7% vs. 79.8% in LRTI, 85.1% vs. 84.5% in throat infections, 80.7% vs. 82.3% in nasal infections, 83.5% vs. 83.8% in unspecified URTI in 1991 and 2012, respectively. Implications After more than two decades, macrolides remained amongst the most effective antibiotic classes for both URTI and LRTI in initial and secondary antibiotic treatment when a further antibiotic course was prescribed. Limitations Antibiotic treatments were classified as intention to treat. It is unknown whether the

  19. Evaluation of ethnic disparities in detection of depression and anxiety in primary care during the maternal period: combined analysis of routine and cohort data

    PubMed Central

    Prady, Stephanie L.; Pickett, Kate E.; Petherick, Emily S.; Gilbody, Simon; Croudace, Tim; Mason, Dan; Sheldon, Trevor A.; Wright, John

    2016-01-01

    Background There are limited data on detection disparities of common mental disorders in minority ethnic women. Aims Describe the natural history of common mental disorders in primary care in the maternal period, characterise women with, and explore ethnic disparities in, detected and potentially missed common mental disorders. Method Secondary analyses of linked birth cohort and primary care data involving 8991 (39.4% White British) women in Bradford. Common mental disorders were characterised through indications in the electronic medical record. Potentially missed common mental disorders were defined as an elevated General Health Questionnaire (GHQ-28) score during pregnancy with no corresponding common mental disorder markers in the medical record. Results Estimated prevalence of pre-birth common mental disorders was 9.5%, rising to 14.0% 3 years postnatally. Up to half of cases were potentially missed. Compared with White British women, minority ethnic women were twice as likely to have potentially missed common mental disorders and half as likely to have a marker of screening for common mental disorders. Conclusions Common mental disorder detection disparities exist for minority ethnic women in the maternal period. PMID:26795424

  20. Primary Care's Dim Prognosis

    ERIC Educational Resources Information Center

    Alper, Philip R.

    2010-01-01

    Given the chorus of approval for primary care emanating from every party to the health reform debate, one might suppose that the future for primary physicians is bright. Yet this is far from certain. And when one looks to history and recognizes that primary care medicine has failed virtually every conceivable market test in recent years, its…

  1. Routine failures in the process for blood testing and the communication of results to patients in primary care in the UK: a qualitative exploration of patient and provider perspectives

    PubMed Central

    Litchfield, Ian; Bentham, Louise; Hill, Ann; McManus, Richard J; Lilford, Richard; Greenfield, Sheila

    2015-01-01

    Background The testing and result communication process in primary care is complex. Its successful completion relies on the coordinated efforts of a range of staff in primary care and external settings working together with patients. Despite the importance of diagnostic testing in provision of care, this complexity renders the process vulnerable in the face of increasing demand, stretched resources and a lack of supporting guidance. Methods We conducted a series of focus groups with patients and staff across four primary care practices using process-improvement strategies to identify and understand areas where either unnecessary delay is introduced, or the process may fail entirely. We then worked with both patients and staff to arrive at practical strategies to improve the current system. Results A total of six areas across the process were identified where improvements could be introduced. These were: (1) delay in phlebotomy, (2) lack of a fail-safe to ensure blood tests are returned to practices and patients, (3) difficulties in accessing results by telephone, (4) role of non-clinical staff in communicating results, (5) routine communication of normal results and (6) lack of a protocol for result communication. Conclusions A number of potential failures in testing and communicating results to patients were identified, and some specific ideas for improving existing systems emerged. These included same-day phlebotomy sessions, use of modern technology methods to proactively communicate routine results and targeted training for receptionists handling sensitive data. There remains an urgent need for further work to test these and other potential solutions. PMID:26251507

  2. What is primary care?

    PubMed

    1983-06-01

    This discussion of primary care directs attention to quality of care and the primary care team. Primary care is the care provided by the 1st person the patient sees who has been trained in health care. The answer to the question of who should provide primary care should be based on the tasks and responsibilities which must be met. These are: correct diagnosis as the precondition for treatment; appropriate treatment to restore maximum possible restoration of function; relief of pain and suffering and alleviation of anxieties associated with illness; appropriate referral for specialized diagnostic, treatment, and rehabilitation services; management responsibility for the overall health of the patient; preventive services, i.e., immunization, multiphasic screening for early detection, and preventive supervision; and health education and advice for health promotion, disease prevention, treatment and rehabilitation. The need for highly trained primary care practitioners is illustrated by a study conducted by Ciocco, Hunt, and Altman as part of the 1946 survey of group practice by the US Public Health Service. In each of 16 medical groups, they abstracted the records of 200 new patients to obtain data on the services received for a period of 14 days following admission. When they compared the 5 groups with the greatest average amount of hospital training of physicians with the 5 groups with the lowest amount, siginificant differences were found. There were more general examinations among patients of the groups in the high set, 46% against 36%, and there were fewer patients for whom no examination was recorded. Significant differences were also found in treatment between the high and low sets. The study implications were clear. The old style general practitioner can hardly be considered competent to provide a high quality of primary care, yet these were the primary care practitioners that the United Mine Workers Association (UMWA) medical care program encountered in the

  3. Academia, Chronic Care, and the Future of Primary Care

    PubMed Central

    2010-01-01

    Most proposals to reform health care delivery center on a robust, well-designed primary care sector capable of reducing the health and cost consequences of major chronic illnesses. Ironically, the intensified policy interest in primary care coincides with a steep decline in the proportion of medical students choosing primary care careers. Negativity stemming from the experience of trying to care for chronically ill patients with complex conditions in poorly designed, chaotic primary care teaching settings may be influencing trainees to choose other career paths. Redesigning teaching clinics so that they routinely provide high quality, well-organized chronic care would appear to be a critical early step in addressing the looming primary care workforce crisis. The Chronic Care Model provides a proven framework for such a redesign, and has been, with organizational support and effort, successfully implemented in academic settings. PMID:20737241

  4. [Primary care in France].

    PubMed

    Sánchez-Sagrado, T

    2016-01-01

    The poor planning of health care professionals in Spain has led to an exodus of doctors leaving the country. France is one of the chosen countries for Spanish doctors to develop their professional career. The French health care system belongs to the Bismarck model. In this model, health care system is financed jointly by workers and employers through payroll deduction. The right to health care is linked to the job, and provision of services is done by sickness-funds controlled by the Government. Primary care in France is quite different from Spanish primary care. General practitioners are independent workers who have the right to set up a practice anywhere in France. This lack of regulation has generated a great problem of "medical desertification" with problems of health care access and inequalities in health. French doctors do not want to work in rural areas or outside cities because "they are not value for money". Medical salary is linked to professional activity. The role of doctors is to give punctual care. Team work team does not exist, and coordination between primary and secondary care is lacking. Access to diagnostic tests, hospitals and specialists is unlimited. Duplicity of services, adverse events and inefficiencies are the norm. Patients can freely choose their doctor, and they have a co-payment for visits and hospital care settings. Two years training is required to become a general practitioner. After that, continuing medical education is compulsory, but it is not regulated. Although the French medical Health System was named by the WHO in 2000 as the best health care system in the world, is it not that good. While primary care in Spain has room for improvement, there is a long way for France to be like Spain.

  5. [Primary care in France].

    PubMed

    Sánchez-Sagrado, T

    2016-01-01

    The poor planning of health care professionals in Spain has led to an exodus of doctors leaving the country. France is one of the chosen countries for Spanish doctors to develop their professional career. The French health care system belongs to the Bismarck model. In this model, health care system is financed jointly by workers and employers through payroll deduction. The right to health care is linked to the job, and provision of services is done by sickness-funds controlled by the Government. Primary care in France is quite different from Spanish primary care. General practitioners are independent workers who have the right to set up a practice anywhere in France. This lack of regulation has generated a great problem of "medical desertification" with problems of health care access and inequalities in health. French doctors do not want to work in rural areas or outside cities because "they are not value for money". Medical salary is linked to professional activity. The role of doctors is to give punctual care. Team work team does not exist, and coordination between primary and secondary care is lacking. Access to diagnostic tests, hospitals and specialists is unlimited. Duplicity of services, adverse events and inefficiencies are the norm. Patients can freely choose their doctor, and they have a co-payment for visits and hospital care settings. Two years training is required to become a general practitioner. After that, continuing medical education is compulsory, but it is not regulated. Although the French medical Health System was named by the WHO in 2000 as the best health care system in the world, is it not that good. While primary care in Spain has room for improvement, there is a long way for France to be like Spain. PMID:26304179

  6. Using routine data to improve palliative and end of life care

    PubMed Central

    Davies, Joanna M; Gao, Wei; Sleeman, Katherine E; Lindsey, Katie; Murtagh, Fliss E; Teno, Joan M; Deliens, Luc; Wee, Bee; Higginson, Irene J; Verne, Julia

    2016-01-01

    Palliative and end of life care is essential to healthcare systems worldwide, yet a minute proportion of research funding is spent on palliative and end of life care research. Routinely collected health and social care data provide an efficient and useful opportunity for evaluating and improving care for patients and families. There are excellent examples of routine data research in palliative and end of life care, but routine data resources are widely underutilised. We held four workshops on using routinely collected health and social care data in palliative and end of life care. Researchers presented studies from the UK, USA and Europe. The aim was to highlight valuable examples of work with routine data including work with death registries, hospital activity records, primary care data and specialist palliative care registers. This article disseminates that work, describes the benefits of routine data research and identifies major challenges for the future use of routine data, including; access to data, improving data linkage, and the need for more palliative and end of life care specific data. PMID:26928173

  7. Using routine data to improve palliative and end of life care.

    PubMed

    Davies, Joanna M; Gao, Wei; Sleeman, Katherine E; Lindsey, Katie; Murtagh, Fliss E; Teno, Joan M; Deliens, Luc; Wee, Bee; Higginson, Irene J; Verne, Julia

    2016-09-01

    Palliative and end of life care is essential to healthcare systems worldwide, yet a minute proportion of research funding is spent on palliative and end of life care research. Routinely collected health and social care data provide an efficient and useful opportunity for evaluating and improving care for patients and families. There are excellent examples of routine data research in palliative and end of life care, but routine data resources are widely underutilised. We held four workshops on using routinely collected health and social care data in palliative and end of life care. Researchers presented studies from the UK, USA and Europe. The aim was to highlight valuable examples of work with routine data including work with death registries, hospital activity records, primary care data and specialist palliative care registers. This article disseminates that work, describes the benefits of routine data research and identifies major challenges for the future use of routine data, including; access to data, improving data linkage, and the need for more palliative and end of life care specific data.

  8. Sparking, supporting and steering change: grounding an accountability framework with viewpoints from Nigerian routine immunization and primary health care government officials.

    PubMed

    George, Asha S; Erchick, Daniel J; Zubairu, Mustafa Mahmud; Barau, Inuwa Yau; Wonodi, Chizoba

    2016-11-01

    Existing accountability efforts in Nigeria primarily serve as retrospective policing. To enable accountability to guide change prospectively and preemptively, we drew from a literature review to develop a framework that highlights mutually reinforcing dimensions of accountability in health systems along three counterbalancing axes. The axis of power sparks change by wielding 'sticks' that curb the potential abuse of power, but also by offering 'carrots' that motivate constructive agency. The axis of ability supports change by enabling service delivery actors with formal rules that appropriately expand their authority to act, but also the informal norms and inputs for improved performance. Last, the axis of justice orients the strategic direction of change, balancing political representation, community ownership and social equity, so that accountability measures are progressive, rather than being captured by self-interests. We consulted Nigerian government officials to understand their viewpoints on accountability and mapped their responses to our evolving framework. All government officials (n = 36) participating in three zonal workshops on routine immunization filled out questionnaires that listed the top three opportunities and challenges to strengthening accountability. Thematically coded responses highlighted dimensions of accountability within the axes of ability and power: clarifying formal roles and responsibilities; transparency, data and monitoring systems; availability of skilled health personnel that are motivated and supervised; addressing informal norms and behaviours; and availability of inputs regarding funding and supplies. Other dimensions of accountability were mentioned but were not as critical from their viewpoints: managerial discretion; sanctions and enforcements; political influence and community engagement. Strikingly, almost no respondents mentioned social equity as being an important aspect of accountability, although a few mentioned

  9. Sparking, supporting and steering change: grounding an accountability framework with viewpoints from Nigerian routine immunization and primary health care government officials.

    PubMed

    George, Asha S; Erchick, Daniel J; Zubairu, Mustafa Mahmud; Barau, Inuwa Yau; Wonodi, Chizoba

    2016-11-01

    Existing accountability efforts in Nigeria primarily serve as retrospective policing. To enable accountability to guide change prospectively and preemptively, we drew from a literature review to develop a framework that highlights mutually reinforcing dimensions of accountability in health systems along three counterbalancing axes. The axis of power sparks change by wielding 'sticks' that curb the potential abuse of power, but also by offering 'carrots' that motivate constructive agency. The axis of ability supports change by enabling service delivery actors with formal rules that appropriately expand their authority to act, but also the informal norms and inputs for improved performance. Last, the axis of justice orients the strategic direction of change, balancing political representation, community ownership and social equity, so that accountability measures are progressive, rather than being captured by self-interests. We consulted Nigerian government officials to understand their viewpoints on accountability and mapped their responses to our evolving framework. All government officials (n = 36) participating in three zonal workshops on routine immunization filled out questionnaires that listed the top three opportunities and challenges to strengthening accountability. Thematically coded responses highlighted dimensions of accountability within the axes of ability and power: clarifying formal roles and responsibilities; transparency, data and monitoring systems; availability of skilled health personnel that are motivated and supervised; addressing informal norms and behaviours; and availability of inputs regarding funding and supplies. Other dimensions of accountability were mentioned but were not as critical from their viewpoints: managerial discretion; sanctions and enforcements; political influence and community engagement. Strikingly, almost no respondents mentioned social equity as being an important aspect of accountability, although a few mentioned

  10. Primary care for refugees.

    PubMed

    Eckstein, Barbara

    2011-02-15

    Over the past decade, at least 600,000 refugees from more than 60 different countries have been resettled in the United States. The personal history of a refugee is often marked by physical and emotional trauma. Although refugees come from many different countries and cultures, their shared pattern of experiences allows for some generalizations to be made about their health care needs and challenges. Before being accepted for resettlement in the United States, all refugees must pass an overseas medical screening examination, the purpose of which is to identify conditions that could result in ineligibility for admission to the United States. Primary care physicians have the opportunity to care for members of this unique population once they resettle. Refugees present to primary care physicians with a variety of health problems, including musculoskeletal and pain issues, mental and social health problems, infectious diseases, and longstanding undiagnosed chronic illnesses. Important infectious diseases to consider in the symptomatic patient include tuberculosis, parasites, and malaria. Health maintenance and immunizations should also be addressed. Language barriers, cross-cultural medicine issues, and low levels of health literacy provide additional challenges to caring for this population. The purpose of this article is to provide primary care physicians with a guide to some of the common issues that arise when caring for refugee patients.

  11. Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis

    PubMed Central

    Hay, Alastair D; Lane, Isabel F; Thornton, Hannah V; Wootton, Mandy; Costelloe, Céire

    2016-01-01

    previous prescriptions for antibiotics in primary care were more likely to be resistant to antibiotics, and this increased risk could persist for up to six months (odds ratio 13.23, 95% confidence interval 7.84 to 22.31). Conclusions Prevalence of resistance to commonly prescribed antibiotics in primary care in children with urinary tract infections caused by E coli is high, particularly in countries outside the OECD, where one possible explanation is the availability of antibiotics over the counter. This could render some antibiotics ineffective as first line treatments for urinary tract infection. Routine use of antibiotics in primary care contributes to antimicrobial resistance in children, which can persist for up to six months after treatment. PMID:26980184

  12. [Primary care in Sweden].

    PubMed

    Sánchez-Sagrado, T

    2016-09-01

    Sweden was one of the first European Union countries that saw the opportunity in the free movement of professionals. First offers for jobs were managed in 2000. Since then, a large number of professionals have taken the opportunity of a decent job and have moved from Spain to Sweden. The Swedish health care model belongs to the group of national health systems. The right to health care is linked to legal citizenship. Health is financed through regional taxes, but there is a compulsory co-payment regardless of the financial situation of the patient. The provision of health care is decentralised at a regional level, and there is a mixture of private and public medical centres. Primary care is similar to that in Spain. Health professionals work as a team with a division of tasks. Like in Spain, waiting lists and coordination between primary and specialised care are a great problem. Patients may register with any public or private primary care centre and hospital provider within their region. Access to diagnostic tests and specialists are restricted to those selected by specialists. Doctors are salaried and their job and salary depend on their experience, professional abilities and regional needs. Medicine is curative. General practitioners are the gateway to the system, but they do not act as gatekeeper. Hospitals offer a number of training post, and the access is through an interview. Continuing medical education is encouraged and financed by the health centre in order to increase its revenues.

  13. Benefits of Aldosterone Receptor Antagonism in Chronic Kidney Disease (BARACK D) trial–a multi-centre, prospective, randomised, open, blinded end-point, 36-month study of 2,616 patients within primary care with stage 3b chronic kidney disease to compare the efficacy of spironolactone 25 mg once daily in addition to routine care on mortality and cardiovascular outcomes versus routine care alone: study protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Chronic kidney disease (CKD) is common and increasing in prevalence. Cardiovascular disease (CVD) is a major cause of morbidity and death in CKD, though of a different phenotype to the general CVD population. Few therapies have proved effective in modifying the increased CVD risk or rate of renal decline in CKD. There are accumulating data that aldosterone receptor antagonists (ARA) may offer cardio-protection and delay renal impairment in patients with the CV phenotype in CKD. The use of ARA in CKD has therefore been increasingly advocated. However, no large study of ARA with renal or CVD outcomes is underway. Methods The study is a prospective randomised open blinded endpoint (PROBE) trial set in primary care where patients will mainly be identified by their GPs or from existing CKD lists. They will be invited if they have been formally diagnosed with CKD stage 3b or there is evidence of stage 3b CKD from blood results (eGFR 30–44 mL/min/1.73 m2) and fulfil the other inclusion/exclusion criteria. Patients will be randomised to either spironolactone 25 mg once daily in addition to routine care or routine care alone and followed-up for 36 months. Discussion BARACK D is a PROBE trial to determine the effect of ARA on mortality and cardiovascular outcomes (onset or progression of CVD) in patients with stage 3b CKD. Trial registration EudraCT: 2012-002672-13 ISRTN: ISRCTN44522369 PMID:24886488

  14. Integrating Palliative Care into Primary Care.

    PubMed

    Gorman, Rosemary D

    2016-09-01

    Improved quality of life, care consistent with patient goals of care, and decreased health care spending are benefits of palliative care. Palliative care is appropriate for anyone with a serious illness. Advances in technology and pharmaceuticals have resulted in increasing numbers of seriously ill individuals, many with a high symptom burden. The numbers of individuals who could benefit from palliative care far outweighs the number of palliative care specialists. To integrate palliative care into primary care it is essential that resources are available to improve generalist palliative care skills, identify appropriate patients and refer complex patients to specialist palliative care providers.

  15. Patient self management of oral anticoagulation in routine care in the UK

    PubMed Central

    McCahon, D; Murray, E T; Jowett, S; Sandhar, H S; Holder, R L; Hussain, S; O'Donoghue, B; Fitzmaurice, D A

    2007-01-01

    Background Self management of anticoagulation: a randomised trial (SMART) was the first large scale UK trial to assess clinical and cost effectiveness of patient self management (PSM) of oral anticoagulation therapy compared to routine care. SMART showed that while PSM was as clinically effective as routine care, it was not as cost effective. SMART adds to the growing body of trial data to support PSM; however there are no data on clinical effectiveness and cost of PSM in routine care. Aim To evaluate clinical effectiveness of PSM compared to routine care outside trial conditions. Methods A retrospective multicentre matched control study. 63 PSM patients from primary care in the West Midlands were matched by age and international normalised ratio (INR) target with controls. INR results were collected for the period 1 July 2003–30 June 2004. The primary outcome measure was INR control. Results 38 PSM and 40 control patients were recruited. INR percentage time in range was 70% PSM vs 64% controls. 60% PSM were having a regular clinical review, 45% were performing an internal quality control (IQC) test and 82% were performing external quality assurance (EQA) on a regular basis. Conclusion PSM outside trial conditions is as clinically effective as routine UK care. PMID:17259295

  16. Increasing Day Care Staff Members' Interactions during Caregiving Routines.

    ERIC Educational Resources Information Center

    Venn, Martha L.; Wolery, Mark

    1992-01-01

    Four paraprofessional staff members in a mainstreamed day care program were trained to engage in positive interactive behaviors during diaper changing. Results indicated that staff increased frequency of game playing and other interactive behaviors during diapering, but increases were not generalized to feeding routines. (Author/JDD)

  17. What Is Primary Care Informatics?

    PubMed Central

    de Lusignan, Simon

    2003-01-01

    Primary care informatics is an emerging academic discipline that remains undefined. The unique nature of primary care necessitates the development of its own informatics discipline. A definition of primary care informatics is proposed, which encompasses the distinctive nature of primary care. The core concepts and theory that should underpin it are described. Primary care informatics is defined as a science and as a subset of health informatics. The proposed definition is intended to focus the development of a generalizable core theory for this informatics subspecialty. PMID:12668690

  18. Primary health care models

    PubMed Central

    Brown, Judith Belle; French, Reta; McCulloch, Amy; Clendinning, Eric

    2012-01-01

    Abstract Objective To explore the knowledge and perceptions of fourth-year medical students regarding the new models of primary health care (PHC) and to ascertain whether that knowledge influenced their decisions to pursue careers in family medicine. Design Qualitative study using semistructured interviews. Setting The Schulich School of Medicine and Dentistry at The University of Western Ontario in London. Participants Fourth-year medical students graduating in 2009 who indicated family medicine as a possible career choice on their Canadian Residency Matching Service applications. Methods Eleven semistructured interviews were conducted between January and April of 2009. Data were analyzed using an iterative and interpretive approach. The analysis strategy of immersion and crystallization assisted in synthesizing the data to provide a comprehensive view of key themes and overarching concepts. Main findings Four key themes were identified: the level of students’ knowledge regarding PHC models varied; the knowledge was generally obtained from practical experiences rather than classroom learning; students could identify both advantages and disadvantages of working within the new PHC models; and although students regarded the new PHC models positively, these models did not influence their decisions to pursue careers in family medicine. Conclusion Knowledge of the new PHC models varies among fourth-year students, indicating a need for improved education strategies in the years before clinical training. Being able to identify advantages and disadvantages of the PHC models was not enough to influence participants’ choice of specialty. Educators and health care policy makers need to determine the best methods to promote and facilitate knowledge transfer about these PHC models. PMID:22518904

  19. Providing Perinatal Mental Health Services in Pediatric Primary Care

    ERIC Educational Resources Information Center

    Talmi, Ayelet; Stafford, Brian; Buchholz, Melissa

    2009-01-01

    After birth, newborns and their caregivers are seen routinely and frequently in pediatric primary care settings. The close succession of visits in the first few months of life puts pediatric primary care professionals in a unique position to enhance infant mental health by developing strong relationships with caregivers, supporting babies and…

  20. Serious mental illness and the role of primary care.

    PubMed

    Planner, Claire; Gask, Linda; Reilly, Siobhan

    2014-08-01

    Policies and guidelines from across the international community are attempting to galvanise action to address the unacceptably high morbidity and mortality rates amongst people with a serious mental illness (SMI). Primary care has a pivotal role to play in translating policy into evidence based practice in conjunction with other providers of health care services. This paper explores the current and potential of role of primary care providers in delivering health care to people with SMI. A review of research in the following key areas of primary health care provision is provided: access, screening and preventative care, routine monitoring and follow-up, diagnosis and delivery of treatments in accordance with guidelines and delivery of interventions. There is undoubtedly a need for further research to establish the effectiveness of primary care interventions and the organisation of services. Equally, understanding how primary care services can deliver high quality care and promoting effective working at the interface with other services must be priorities.

  1. Mental health collaborative care and its role in primary care settings.

    PubMed

    Goodrich, David E; Kilbourne, Amy M; Nord, Kristina M; Bauer, Mark S

    2013-08-01

    Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems, as well as engaging patients in their care through self-management support and linkages to community resources. The model is also a cost-efficient strategy for primary care practices to improve outcomes for a range of mental health conditions across populations and settings. CCMs can help achieve integrated care aims underhealth care reform yet organizational and financial issues may affect adoption into routine primary care. Notably, successful implementation of CCMs in routine care will require alignment of financial incentives to support systems redesign investments, reimbursements for mental health providers, and adaptation across different practice settings and infrastructure to offer all CCM components. PMID:23881714

  2. Primary care psychiatry in Italy.

    PubMed

    Berardi, Domenico; Ferrannini, Luigi; Menchetti, Marco; Vaggi, Marco

    2014-06-01

    In Italy, the importance of integrating primary care and mental health has only recently been grasped. Several reasons may explain this delay: a) until 2005, primary care physicians worked individually instead of in group practices, without any functional network or structured contacts with colleagues; b) community mental health centers with multiprofessional teams were well structured and widespread in several regions but focused on people with severe and persistent mental disorders; and c) specific national government health policies were lacking. Only two regions have implemented explicit policies on this issue. The "G. Leggieri" program started by the Emilia-Romagna region health government in 1999 aims to coordinate unsolicited bottom-up cooperation initiatives developing since the 1980s. In Liguria, a regional work group was established in 2010 to boost the strategic role of collaborative programs between primary care and mental health services. This article describes the most innovative experiences relating to primary care psychiatry in Italy.

  3. Choosing a primary care provider

    MedlinePlus

    Family doctor - how to choose one; Primary care provider - how to choose one; Doctor - how to choose a family doctor ... A PCP is your main health care provider in non-emergency ... and teach healthy lifestyle choices Identify and treat common ...

  4. Developing a neighborhood primary care strategy.

    PubMed

    Halley, Marc D; Montijo, Sarah D; Gentz, Dale L; Miro, Lauri M

    2015-11-01

    For building and maintaining a primary care workforce to staff an integrated care delivery strategy, considerations include: > Geographic presence > Patient care modeling > Professional staffing. PMID:26685439

  5. Phytotherapy in primary health care

    PubMed Central

    Antonio, Gisele Damian; Tesser, Charles Dalcanale; Moretti-Pires, Rodrigo Otavio

    2014-01-01

    OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population. PMID:25119949

  6. Primary medical care in Seychelles.

    PubMed

    Sullivan, F M; Shamlaye, C

    1992-07-01

    This paper describes some of the current health problems faced by a tropical country whose standard of living and lifestyle is approaching that of many countries in Western Europe. Long-term health problems such as cardiovascular diseases and diabetes have become at least as important as infectious diseases. A change in approach to a more proactive style of primary care is needed to allow the contribution of community doctors to be effective. The system of primary care in the Republic of Seychelles is based on the UK model of general practice where recent improvements in education and organization are raising standards. How some of these improvements might be transferred elsewhere is discussed.

  7. Improving access to a primary care medical clinic.

    PubMed Central

    Meditz, R. W.; Manberg, C. L.; Rosner, F.

    1992-01-01

    Patients presenting to an episodic care walk-in clinic often warrant prompt but not necessarily emergency attention. Legitimate reasons often prohibit these patients from attending regularly scheduled daytime weekday clinics. Most patients interviewed thought that having a single primary care provider was important to ensure continuity of care. Access to primary care can be improved by scheduling clinics and ancillary services on nontraditional times and days. Enhanced communication can help patients differentiate routine from urgent from emergency conditions. Printed and audiovisual materials can be used to increase awareness of the benefits of comprehensive care. PMID:1507251

  8. Primary care: can it solve employers' health care dilemma?

    PubMed

    Sepulveda, Martin-J; Bodenheimer, Thomas; Grundy, Paul

    2008-01-01

    Employers are beginning to recognize that investing in the primary care foundation of the health care system may help address their problems of rising health care costs and uneven quality. Primary care faces a crisis as a growing number of U.S. medical graduates are avoiding primary care careers because of relatively low reimbursement and an unsatisfying work life. Yet a strong primary care sector has been associated with reduced health care costs and improved quality. Through the Patient-Centered Primary Care Collaborative and other efforts, some large employers are engaged in initiatives to strengthen primary care. PMID:18180490

  9. Incorporating Spirituality in Primary Care.

    PubMed

    Isaac, Kathleen S; Hay, Jennifer L; Lubetkin, Erica I

    2016-06-01

    Addressing cultural competency in health care involves recognizing the diverse characteristics of the patient population and understanding how they impact patient care. Spirituality is an aspect of cultural identity that has become increasingly recognized for its potential to impact health behaviors and healthcare decision-making. We consider the complex relationship between spirituality and health, exploring the role of spirituality in primary care, and consider the inclusion of spirituality in existing models of health promotion. We discuss the feasibility of incorporating spirituality into clinical practice, offering suggestions for physicians. PMID:26832335

  10. Treating impetigo in primary care.

    PubMed

    2007-01-01

    Impetigo is a superficial, but contagious, bacterial infection of the skin that predominantly affects children and is common in primary care. In UK general practice, around half of the people with impetigo are treated with topical fusidic acid. However, bacterial resistance to this antibacterial drug is increasing. Here we discuss how patients with impetigo should be treated.

  11. Pharmacists and the primary care workforce.

    PubMed

    Smith, Marie A

    2012-11-01

    The primary care workforce shortage will be magnified by the growing elderly population and expanded coverage as a result of health care reform initiatives. The pharmacist workforce consists of community-based health care professionals who are well trained and highly accessible, yet underutilized. Some health care professionals have advocated that primary care teams should include pharmacists with complementary skills to those of the physician to achieve quality improvement goals and enhance primary care practice efficiencies. New primary care delivery models such as medical homes, health neighborhoods, and accountable care organizations provide opportunities for pharmacists to become integral members of primary care interdisciplinary teams.

  12. Pediatric primary care as a component of systems of care.

    PubMed

    Brown, Jonathan D

    2010-02-01

    Systems of care should be defined in a manner that includes primary care. The current definition of systems of care shares several attributes with the definition of primary care: both are defined as community-based services that are accessible, accountable, comprehensive, coordinated, culturally competent, and family focused. However, systems of care is defined as serving only children and youth with serious emotional disturbance and their families and does not fully embrace the concept of primary prevention. Although similarities in the definitions of primary care and systems of care may provide a theoretical foundation for including primary care within the systems of care framework, a definition of systems of care that incorporates the idea of prevention and takes into account the broad population served in primary care would provide communities with a definition that can be used to further the work of integrating primary care into systems of care.

  13. Learning from UK primary care.

    PubMed

    Hays, Richard

    2009-03-01

    The Australian Government is wise to examine other health care systems as it strives to improve the quality of care and address rising costs to both governments and individuals. Focus is currently on the United Kingdom, whose National Health Service (NHS) stands out as one that delivers good care at a reasonable price to all who need it. The Australian and UK systems have many similarities: universal access, tax payer support, no or low cost at point of delivery, and good population health outcomes. They also face similar pressures on services from aging, increasingly unwell yet expectant populations.However, there are also differences, largely in the way that health care is funded, organised and delivered. The NHS is a huge system for 60 million people in four home countries with diverging policies. Within England, the system is managed through 10 strategic health authorities, each responsible for about 5 million people and having the right to interpret national policy. Population based health care, including tertiary care, is funded locally via primary care trusts. PMID:19283244

  14. Non-Routine Problems in Primary Mathematics Workbooks from Romania

    ERIC Educational Resources Information Center

    Marchis, Iuliana

    2012-01-01

    The aim of this paper is to present a research on Hungarian 3th grade primary school textbooks from Romania. These textbooks are analyzed using two classifications. The first classification is based on how much creativity and problem solving skills pupils need to solve a given task. In this classification problems are gouped in three categories:…

  15. Use of primary care data for detecting impetigo trends, United kingdom, 1995-2010.

    PubMed

    Shallcross, Laura J; Petersen, Irene; Rosenthal, Joe; Johnson, Anne M; Freemantle, Nick; Hayward, Andrew C

    2013-10-01

    Using a primary care database, we identified a major increase in impetigo in the United Kingdom during 1995-2010. Despite a doubled rate of primary care consultations, this increase was not identified by routine surveillance. Primary care databases are a valuable and underused source of surveillance data on infectious diseases. PMID:24047615

  16. Use of primary care data for detecting impetigo trends, United kingdom, 1995-2010.

    PubMed

    Shallcross, Laura J; Petersen, Irene; Rosenthal, Joe; Johnson, Anne M; Freemantle, Nick; Hayward, Andrew C

    2013-10-01

    Using a primary care database, we identified a major increase in impetigo in the United Kingdom during 1995-2010. Despite a doubled rate of primary care consultations, this increase was not identified by routine surveillance. Primary care databases are a valuable and underused source of surveillance data on infectious diseases.

  17. Primary-care physician compensation.

    PubMed

    Olson, Arik

    2012-01-01

    This article reviews existing models of physician compensation and presents information about current compensation patterns for primary-care physicians in the United States. Theories of work motivation are reviewed where they have relevance to the desired outcome of satisfied, productive physicians whose skills and expertise are retained in the workforce. Healthcare reforms that purport to bring accountability for healthcare quality and value-rather than simply volume-bring opportunities to redesign primary-care physician compensation and may allow for new compensation methodologies that increase job satisfaction. Physicians are increasingly shunning the responsibility of private practice and choosing to work as employees of a larger organization, often a hospital. Employers of physicians are seeking compensation models that reward both productivity and value. PMID:22786738

  18. Primary and secondary care integration.

    PubMed

    McCormick, I R; Boyd, M A

    1994-10-26

    Integration of primary and secondary health care is a goal of the 1993 New Zealand health reforms. Focus groups were selected to raise options and stimulate improved integration between primary and secondary care in the Auckland metropolitan and rural areas. Cooperation, communication, coordination, were considered relevant. Several detailed recommendations were produced. They fell into six groups; (1) liaison committees or meetings, (2) communication, (3) referral admission discharge, (4) joint ventures, (5) horizontal integration and (6) general. A key recommendation was that regional health authorities should fund liaison committees or functions to promote inter provider integration. The findings of the focus groups are placed in context of the wider requirements for integration. These are integrated funding, integrated information systems, integrated purchasing and utilisation management.

  19. Measuring the Attainment of Primary Care.

    ERIC Educational Resources Information Center

    Starfield, Barbara

    1979-01-01

    The definition of primary care is developed and a way is suggested to measure whether it is being achieved. Evaluative questions are identified that can determine whether a system of care is oriented toward primary care. They include assessing first-contact care, coordination of care, comprehensiveness, and longitudinality. (LBH)

  20. Cancer genetics in primary care.

    PubMed

    McKelvey, Kent D; Evans, James P

    2003-11-01

    Primary care physicians are in a unique position to apply recent advances in cancer genetics to the improved care of their patients. Although the impact of our burgeoning knowledge in this area is significant and growing, it is often incompletely understood by the general practitioner. In this article we review the genetic basis of cancer and focus attention on inherited forms of cancer using breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) as examples. Specific attributes of family and personal history are the most significant indicators of an increased risk of cancer in the individual patient. Genetic testing can be used to further assess risk and guide strategies for cancer screening, prevention, and treatment. However, the decision of whether to pursue genetic testing and the interpretation of results are complex. We review factors involved in these decisions as well as the implications, risks, and benefits of genetic testing for the individual and the family.

  1. 45 CFR 96.47 - Primary care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... and Tribal Organizations § 96.47 Primary care. Applications for direct funding of Indian tribes and tribal organizations under the primary care block grant must comply with 42 CFR Part 51c (Grants for... 45 Public Welfare 1 2010-10-01 2010-10-01 false Primary care. 96.47 Section 96.47 Public...

  2. Screening and Identification in Pediatric Primary Care

    ERIC Educational Resources Information Center

    Simonian, Susan J.

    2006-01-01

    This article reviews issues related to behavioral screening in pediatric primary care settings. Structural-organizational issues affecting the use of pediatric primary care screening are discussed. This study also reviewed selected screening instruments that have utility for use in the primary care setting. Clinical and research issues related to…

  3. 45 CFR 96.47 - Primary care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... and Tribal Organizations § 96.47 Primary care. Applications for direct funding of Indian tribes and tribal organizations under the primary care block grant must comply with 42 CFR Part 51c (Grants for... 45 Public Welfare 1 2011-10-01 2011-10-01 false Primary care. 96.47 Section 96.47 Public...

  4. Psychopharmacology in Primary Care Settings.

    PubMed

    Benich, Joseph J; Bragg, Scott W; Freedy, John R

    2016-06-01

    Psychopharmacology requires clinicians to stay current on the latest guidelines and to use dynamic treatment strategies. Psychiatric conditions are prevalent in the primary care population. Choice of treatment with psychopharmacology should be based on controlling the patient's predominant symptoms while taking into consideration patient age, treatment compliance, patient past response to treatments, dosing frequency, patient preference, medication side effects, potential medication interactions, drug precautions/warnings, and cost. Response to therapy, as well as side effects, needs to be evaluated at regular intervals. The goal is to minimize symptoms and return patients to their maximal level of functioning.

  5. Primary care and care for older persons: position paper of the European Forum for Primary Care.

    PubMed

    Boeckxstaens, Pauline; De Graaf, Pim

    2011-01-01

    This article explores how to address the needs of the growing number of older patients in primary care practice. Primary care is not a fixed organisational structure but a combination of functional characteristics which has developed variably in European countries with differing responses to the emerging needs of older persons. Multimorbidity, frailty, disability and dependence play out differently in older persons; a key challenge for primary care is to provide a response that is adapted to the needs of individuals - as they see them and not as the professional defines them. Indeed, growing experience shows how to involve older persons in taking decisions. Contrary to popular opinion, older persons often rate their quality of life as high. Indeed, comprehensive primary care offers health promotion and prevention: also older people may benefit from measures that support their health and independence and some case descriptions show this potential. Although most people prefer to be in their own environment (home, community) during the last stage of life, providing end-of-life care in the community is a challenge for primary care because it requires continuity and coordination with specialist care. Successful models of care however do exist. Delivering seamless integrated care to older persons is a central theme in primary care. Rather than disease management, in primary care, case management is the preferred approach. Proactive geriatric assessment of individual medical, functional and social needs, including loneliness and isolation, has been shown to be useful and its place in primary care is the subject of further research. Clinical practice guidelines for multimorbidity are badly needed. Non-adherence to medication, linked to multiple and uncoordinated prescriptions, is a widespread and costly problem. Successful approaches in primary care are being developed, including the use of electronic patient files. With the general practitioner (GP) as the central care

  6. Pediatric Primary Care as a Component of Systems of Care

    ERIC Educational Resources Information Center

    Brown, Jonathan D.

    2010-01-01

    Systems of care should be defined in a manner that includes primary care. The current definition of systems of care shares several attributes with the definition of primary care: both are defined as community-based services that are accessible, accountable, comprehensive, coordinated, culturally competent, and family focused. However, systems of…

  7. Primary Care of the Renal Transplant Patient

    PubMed Central

    Unruh, Mark L.; Nolin, Thomas D.; Hasley, Peggy B.

    2010-01-01

    There has been a remarkable rise in the number of kidney transplant recipients (KTR) in the US over the last decade. Increasing use of potent immunosuppressants, which are also potentially diabetogenic and atherogenic, can result in worsening of pre-existing medical conditions as well as development of post-transplant disease. This, coupled with improving long-term survival, is putting tremendous pressure on transplant centers that were not designed to deliver primary care to KTR. Thus, increasing numbers of KTR will present to their primary care physicians (PCP) post-transplant for routine medical care. Similar to native chronic kidney disease patients, KTRs are vulnerable to cardiovascular disease as well as a host of other problems including bone disease, infections and malignancies. Deaths related to complications of cardiovascular disease and malignancies account for 60–65% of long-term mortality among KTRs. Guidelines from the National Kidney Foundation and the European Best Practice Guidelines Expert Group on the management of hypertension, dyslipidemia, smoking, diabetes and bone disease should be incorporated into the long-term care plan of the KTR to improve outcomes. A number of transplant centers do not supply PCPs with protocols and guidelines, making the task of the PCP more difficult. Despite this, PCPs are expected to continue to provide general preventive medicine, vaccinations and management of chronic medical problems. In this narrative review, we examine the common medical problems seen in KTR from the PCP’s perspective. Medical management issues related to immunosuppressive medications are also briefly discussed. PMID:20422302

  8. Incorporating immunizations into routine obstetric care to facilitate Health Care Practitioners in implementing maternal immunization recommendations

    PubMed Central

    Webb, Heather; Street, Jackie; Marshall, Helen

    2014-01-01

    Immunization against pertussis, influenza, and rubella reduces morbidity and mortality in pregnant women and their offspring. Health care professionals (HCPs) caring for women perinatally are uniquely placed to reduce maternal vaccine preventable diseases (VPDs). Despite guidelines recommending immunization during the perinatal period, maternal vaccine uptake remains low. This qualitative study explored the role of obstetricians, general practitioners, and midwives in maternal vaccine uptake. Semi-structured interviews (n = 15) were conducted with perinatal HCPs at a tertiary maternity hospital in South Australia. HCPs were asked to reflect on their knowledge, beliefs, and practice relating to immunization advice and vaccine provision. Interviews were transcribed and coded using thematic analysis. Data collection and analysis was an iterative process, with collection ceasing with theoretical saturation. Participants unanimously supported maternal vaccination as an effective way of reducing risk of disease in this vulnerable population, however only rubella immunity detection and immunization is embedded in routine care. Among these professionals, delegation of responsibility for maternal immunization was unclear and knowledge about maternal immunization was variable. Influenza and pertussis vaccine prevention measures were not included in standard pregnancy record documentation, information provision to patients was “ad hoc” and vaccinations not offered on-site. The key finding was that the incorporation of maternal vaccinations into standard care through a structured process is an important facilitator for immunization uptake. Incorporating vaccine preventable disease management measures into routine obstetric care including incorporation into the Pregnancy Record would facilitate HCPs in implementing recommendations. Rubella prevention provides a useful “template” for other vaccines. PMID:24509790

  9. Primary Care for Adults with Down Syndrome: Adherence to Preventive Healthcare Recommendations

    ERIC Educational Resources Information Center

    Jensen, K. M.; Taylor, L. C.; Davis, M. M.

    2013-01-01

    Background: Due to significant medical improvements, persons with Down syndrome now live well into adulthood. Consequently, primary care for adults with Down syndrome needs to incorporate routine care with screening for condition-specific comorbidities. This study seeks to evaluate the adherence of primary care physicians to age- and…

  10. Changes in Young Adult Primary Care Under the Affordable Care Act

    PubMed Central

    Ford, Carol A.; French, Benjamin; Rubin, David M.

    2015-01-01

    Objectives. We sought to describe changes in young adults’ routine care and usual sources of care (USCs), according to provider specialty, after implementation of extended dependent coverage under the Affordable Care Act (ACA) in 2010. Methods. We used Medical Expenditure Panel Survey data from 2006 to 2012 to examine young adults’ receipt of routine care in the preceding year, identification of a USC, and USC provider specialties (pediatrics, family medicine, internal medicine, and obstetrics and gynecology). Results. The percentage of young adults who sought routine care increased from 42.4% in 2006 to 49.5% in 2012 (P < .001). The percentage identifying a USC remained stable at approximately 60%. Among young adults with a USC, there was a trend between 2006 and 2012 toward increasing percentages with pediatric (7.6% vs 9.1%) and family medicine (75.9% vs 80.9%) providers and declining percentages with internal medicine (11.5% vs 7.6%) and obstetrics and gynecology (5.0% vs 2.5%) providers. Conclusions. Efforts under the ACA to increase health insurance coverage had favorable effects on young adults’ use of routine care. Monitoring routine care use and USC choices in this group can inform primary care workforce needs and graduate medical education priorities across specialties. PMID:26447914

  11. Why Medical Students Choose Primary Care Careers.

    ERIC Educational Resources Information Center

    Kassler, William J.; And Others

    1991-01-01

    A study of factors influencing medical students to choose primary care careers, in contrast with high-technology careers, found students attracted by opportunity to provide direct care, ambulatory care, continuity of care, and involvement in psychosocial aspects of care. Age, race, gender, marital status, and some attitudes were not influential.…

  12. The adoption of the Reference Framework for diabetes care among primary care physicians in primary care settings

    PubMed Central

    Wong, Martin C.S.; Wang, Harry H.X.; Kwan, Mandy W.M.; Chan, Wai Man; Fan, Carmen K.M.; Liang, Miaoyin; Li, Shannon TS; Fung, Franklin D.H.; Yeung, Ming Sze; Chan, David K.L.; Griffiths, Sian M.

    2016-01-01

    Abstract The prevalence of diabetes mellitus has been increasing both globally and locally. Primary care physicians (PCPs) are in a privileged position to provide first contact and continuing care for diabetic patients. A territory-wide Reference Framework for Diabetes Care for Adults has been released by the Hong Kong Primary Care Office in 2010, with the aim to further enhance evidence-based and high quality care for diabetes in the primary care setting through wide adoption of the Reference Framework. A valid questionnaire survey was conducted among PCPs to evaluate the levels of, and the factors associated with, their adoption of the Reference Framework. A total of 414 completed surveys were received with the response rate of 13.0%. The average adoption score was 3.29 (SD 0.51) out of 4. Approximately 70% of PCPs highly adopted the Reference Framework in their routine practice. Binary logistic regression analysis showed that the PCPs perceptions on the inclusion of sufficient local information (adjusted odds ratio [aOR] = 4.748, 95%CI 1.597–14.115, P = 0.005) and reduction of professional autonomy of PCPs (aOR = 1.859, 95%CI 1.013–3.411, P = 0.045) were more likely to influence their adoption level of the Reference Framework for diabetes care in daily practices. The overall level of guideline adoption was found to be relatively high among PCPs for adult diabetes in primary care settings. The adoption barriers identified in this study should be addressed in the continuous updating of the Reference Framework. Strategies need to be considered to enhance the guideline adoption and implementation capacity. PMID:27495018

  13. Caring for breast cancer survivors in primary care.

    PubMed

    Trotter, Kathryn; Stouder, April

    2016-10-01

    Women with a history of breast cancer compose the largest group of cancer survivors. Physician assistants and nurse practitioners can play a key role in caring for cancer survivors in primary care settings. This article provides a brief overview and synthesis of current breast cancer guidelines, other resources, and clinical observations that may help primary care providers to translate plans developed by oncology specialists into primary care delivery. PMID:27623290

  14. Psychiatric morbidity in primary care.

    PubMed

    al-Haddad, M K; al-Garf, A; al-Jowder, S; al-Zurba, F I

    1999-01-01

    The prevalence of hidden psychiatric morbidity was assessed using the General Health Questionnaire (GHQ) and Hospital Anxiety Depression Scale (HAD). A total of 149 Bahraini patients aged > or = 16 years were selected randomly from those attending primary health care centres for problems other than psychiatric illness. The prevalence of psychiatric morbidity using GHQ was 45.1% (cut-off > or = 5) and 27.1% (cut-off > or = 9). Using the HAD scale, the prevalence was 44.4% (cut-off > or = 8) and 23.6% (cut-off > or = 11). Psychiatric morbidity was more common in women aged 50-55 years, in divorcees or widows and in lesser educated patients. Either instrument could be used to diagnose psychiatric illness.

  15. Step 4: Get Routine Care to Avoid Problems | NIH MedlinePlus the Magazine

    MedlinePlus

    ... Diabetes Step 4: Get Routine Care to Avoid Problems Past Issues / Fall 2014 Table of Contents Accelerating Medicines Partnership (AMP—Part 3 of 4) Type 2 Diabetes The NIH, pharmaceutical companies, and nonprofit organizations have together created the Accelerating ...

  16. Time Allocation in Primary Care Office Visits

    PubMed Central

    Tai-Seale, Ming; McGuire, Thomas G; Zhang, Weimin

    2007-01-01

    Objectives To use an innovative videotape analysis method to examine how clinic time was spent during elderly patients' visits to primary care physicians. Secondary objectives were to identify the factors that influence time allocations. Data Sources A convenience sample of 392 videotapes of routine office visits conducted between 1998 and 2000 from multiple primary care practices in the United States, supplemented by patient and physician surveys. Research Design Videotaped visits were examined for visit length and time devoted to specific topics—a novel approach to study time allocation. A survival analysis model analyzed the effects of patient, physician, and physician practice setting on how clinic time was spent. Principal Findings Very limited amount of time was dedicated to specific topics in office visits. The median visit length was 15.7 minutes covering a median of six topics. About 5 minutes were spent on the longest topic whereas the remaining topics each received 1.1 minutes. While time spent by patient and physician on a topic responded to many factors, length of the visit overall varied little even when contents of visits varied widely. Macro factors associated with each site had more influence on visit and topic length than the nature of the problem patients presented. Conclusions Many topics compete for visit time, resulting in small amount of time being spent on each topic. A highly regimented schedule might interfere with having sufficient time for patients with complex or multiple problems. Efforts to improve the quality of care need to recognize the time pressure on both patients and physicians, the effects of financial incentives, and the time costs of improving patient–physician interactions. PMID:17850524

  17. Primary care for the Roma in Europe: Position paper of the European forum for primary care

    PubMed Central

    Rotar Pavlič, Danica; Zelko, Erika; Vintges, Marga; Willems, Sara; Hanssens, Lise

    2016-01-01

    Abstract Roma populations’ low health status and limited access to health services, including primary care, has been documented in many European countries, and warrants specific health policies and practices. A variety of experiences shows how primary care can adjust its practices to reduce the barriers to primary care for Roma populations. At local level, establishing collaboration with Roma organisations helps primary care to improve mutual relations and quality of care. Mediation has proved to be an effective tool. Skills training of primary care practitioners may enhance their individual competences. Research and international sharing of experiences are further tools to improve primary care for the Roma people. PMID:27703542

  18. Addressing Arkansas' rural primary care challenges.

    PubMed

    Goldsmith, G

    1993-10-01

    Universal health coverage may become a reality by the year 2000 and implies a greater need for primary care physicians in rural Arkansas in the 21st century. We can start this decade to build the capacity for an outstanding rural primary care system for the next century. The number of rural primary care physicians can be increased by 1) placing a high priority on recruiting more students to primary care, 2) improving the attractiveness of rural practice, and 3) improving the long-term financial viability of rural primary care. The quality of rural primary care will be greatly influenced by changes in information technology. Medical outreach activities from urban centers to rural communities and changes in rural medical infrastructures will be necessary as we approach the year 2000.

  19. Patient Characteristics Associated with Measurement of Routine Diabetes Care: An Observational Study

    PubMed Central

    Van Doorn-Klomberg, Arna L.; Braspenning, Jozé C. C.; Atsma, Femke; Jansen, Birgit; Bouma, Margriet; Wolters, René J.; Wensing, Michel

    2015-01-01

    Background Non-modifiable patient characteristics, including age, gender, ethnicity as well as the occurrence of multi-morbidities, are associated with processes and outcomes of diabetes care. Information on these factors can be used in case mix adjustment of performance measures. However, the practical relevance of such adjustment is not clear. The aim of this study was to assess the strength of associations between patient factors and diabetes care processes and outcomes. Methods We performed an observational study based on routinely collected data of 12,498 diabetes patients in 59 Dutch primary care practices. Data were collected on patient age, gender, whether the patient lived in a deprived area, body mass index and the co-occurrence of cardiovascular disease, chronic obstructive pulmonary disease, depression or anxiety. Outcomes included 6 dichotomous measures (3 process and 3 outcome related) regarding glycosylated hemoglobin, systolic blood pressure and low density lipoprotein-cholesterol. We performed separate hierarchical logistic mixed model regression models for each of the outcome measures. Results Each of the process measure models showed moderate effect sizes, with pooled areas under the curve that varied between 0.66 and 0.76. The frequency of diabetes related consultations as a measure of patient compliance to treatment showed the strongest association with all process measures (odds ratios between 5.6 and 14.5). The effect sizes of the outcome measure models were considerably smaller than the process measure models, with pooled areas under the curve varying from 0.57 to 0.61. Conclusions Several non-modifiable patient factors could be associated with processes and outcomes of diabetes care. However, associations were small. These results suggest that case-mix correction or stratification in assessing diabetes care has limited practical relevance. PMID:25822978

  20. Can Primary Care Sleep Medicine Integration Work?

    PubMed Central

    Hurwitz, Thomas D.; Herr, Adam; Thuras, Paul; Cook, Brian

    2014-01-01

    Sleep disorders are common in the veteran population. There is an increasing need for sleep medicine services in returning veterans. Primary care providers are uncomfortable diagnosing and treating sleep disorders. Patients often have to wait several days before they can be seen by a sleep clinician. This pilot project evaluated the feasibility of providing sleep medicine services to patients in a primary care setting. Primary care providers were involved in decision-making, resulting in improved satisfaction with sleep medicine services among primary care clinicians. PMID:25133050

  1. Health care reform and the primary care workforce bottleneck.

    PubMed

    Schwartz, Mark D

    2012-04-01

    To establish and sustain the high-performing health care system envisioned in the Affordable Care Act (ACA), current provisions in the law to strengthen the primary care workforce must be funded, implemented, and tested. However, the United States is heading towards a severe primary care workforce bottleneck due to ballooning demand and vanishing supply. Demand will be fueled by the "silver tsunami" of 80 million Americans retiring over the next 20 years and the expanded insurance coverage for 32 million Americans in the ACA. The primary care workforce is declining because of decreased production and accelerated attrition. To mitigate the looming primary care bottleneck, even bolder policies will be needed to attract, train, and sustain a sufficient number of primary care professionals. General internists must continue their vital leadership in this effort. PMID:22042605

  2. Evaluating primary care research networks.

    PubMed

    Fenton, Evelyn; Harvey, Janet; Sturt, Jackie

    2007-08-01

    This paper presents a conceptual framework and tool kit, generated from the evaluation of five primary care research networks (PCRNs) funded by the then London, National Health Service (NHS) Executive. We employed qualitative methods designed to match the most important characteristics of PCRNs, conducting five contextualized case studies covering the five networks. A conceptual evaluation framework based on a review of the organization science literature was developed and comprised the broad, but inter-related organizational dimensions of structure, processes, boundaries and network self-evaluation as input factors and strategic emphasis as epitomized by network objectives. These dimensions were comprised of more detailed subdimensions designed to capture the potential of the networks to create ideas and knowledge, or intellectual capital, the key construct upon which our evaluation tool kit was based. We considered the congruence, or fit, between network objectives and input factors: greater congruence implied greater ability to achieve implicit and overt objectives. We conclude that network evaluation must take place, over time, recognizing stage of development and potential for long-term viability, but within a generic framework of inputs and outputs. If there is a good fit or congruence between their input factors and network objectives, networks will be internally coherent and able to operate at optimum effectiveness. PMID:17683655

  3. Integrating Behavioral Health into Primary Care.

    PubMed

    McGough, Peter M; Bauer, Amy M; Collins, Laura; Dugdale, David C

    2016-04-01

    Depression is one of the more common diagnoses encountered in primary care, and primary care in turn provides the majority of care for patients with depression. Many approaches have been tried in efforts to improve the outcomes of depression management. This article outlines the partnership between the University of Washington (UW) Neighborhood Clinics and the UW Department of Psychiatry in implementing a collaborative care approach to integrating the management of anxiety and depression in the ambulatory primary care setting. This program was built on the chronic care model, which utilizes a team approach to caring for the patient. In addition to the patient and the primary care provider (PCP), the team included a medical social worker (MSW) as care manager and a psychiatrist as team consultant. The MSW would manage a registry of patients with depression at a clinic with several PCPs, contacting the patients on a regular basis to assess their status, and consulting with the psychiatrist on a weekly basis to discuss patients who were not achieving the goals of care. Any recommendation (eg, a change in medication dose or class) made by the psychiatrist was communicated to the PCP, who in turn would work with the patient on the new recommendation. This collaborative care approach resulted in a significant improvement in the number of patients who achieved care plan goals. The authors believe this is an effective method for health systems to integrate mental health services into primary care. (Population Health Management 2016;19:81-87). PMID:26348355

  4. Safety and effectiveness of dabigatran and warfarin in routine care of patients with atrial fibrillation.

    PubMed

    Seeger, John D; Bykov, Katsiaryna; Bartels, Dorothee B; Huybrechts, Krista; Zint, Kristina; Schneeweiss, Sebastian

    2015-11-25

    The RE-LY study demonstrated the safety and efficacy of dabigatran relative to warfarin for stroke prevention in non-valvular atrial fibrillation. It is important to further evaluate safety and effectiveness of drugs in routine care. This study used a sequential cohort design with propensity score matching to compare dabigatran with warfarin among patients in two commercial health insurance databases. New users of these anticoagulants were followed from initiation until discontinuation, the end of the study, or the occurrence of a study outcome (primary study outcomes were stroke and major bleeding). Proportional hazards regression was conducted separately within each data source and results were pooled. Among 19,189 matched dabigatran and warfarin initiators (mean age: 68 years, 36 % female), as-treated follow-up (average of 5 months for dabigatran, 4 months for warfarin) identified 62 and 69 strokes, respectively (pooled HR = 0.77; 95 % CI = 0.54 to 1.09), and 354 and 395 major haemorrhages, respectively (HR = 0.75; 0.65 to 0.87). No meaningful heterogeneity was identified across subgroups, but numeric trends suggest more pronounced stroke prevention by dabigatran relative to warfarin among patients age 75+ (HR = 0.57; 0.33 to 0.97) or with < 6 months of use (HR = 0.51; 0.19 to 1.42). Major bleeds were reduced more by dabigatran among patients aged < 55 (HR = 0.51; 0.30 to 0.87) and with CHADS2 < 2 (HR = 0.58; 0.44 to 0.77). In conclusion, in routine care of patients with non-valvular atrial fibrillation, dabigatran treatment resulted in improved health outcomes compared with warfarin.

  5. Addressing the primary care workforce crisis.

    PubMed

    Song, Zirui; Chopra, Vineet; McMahon, Laurence F

    2015-01-01

    Our nation's primary care system is in crisis. As medical homes and accountable care organizations increasingly rely on a strong primary care workforce, the shortage of primary care physicians now calls for more policy attention and urgency. In the spirit of the 2014 Institute of Medicine recommendations on graduate medical education (GME) funding, we propose that CMS explicitly reward teaching hospitals if a certain share of their graduates (we propose 30%) remain in primary care 3 years after residency, either through additional payments or release of a withhold. Such a policy could allow hospitals to retain GME funding at a time when continued federal subsidization of GME is being called into question. Moreover, hospitals stand to benefit from producing primary care physicians, both under traditional fee-for-service contracts that reward volume through referrals and, especially, under risk contracts that reward for greater numbers of covered lives. PMID:26618225

  6. Addressing the primary care workforce crisis.

    PubMed

    Song, Zirui; Chopra, Vineet; McMahon, Laurence F

    2015-08-01

    Our nation’s primary care system is in crisis. As medical homes and accountable care organizations increasingly rely on a strong primary care workforce, the shortage of primary care physicians now calls for more policy attention and urgency. In the spirit of the 2014 Institute of Medicine recommendations on graduate medical education (GME) funding, we propose that CMS explicitly reward teaching hospitals if a certain share of their graduates (we propose 30%) remain in primary care 3 years after residency, either through additional payments or release of a withhold. Such a policy could allow hospitals to retain GME funding at a time when continued federal subsidization of GME is being called into question. Moreover, hospitals stand to benefit from producing primary care physicians, both under traditional fee-for-service contracts that reward volume through referrals and, especially, under risk contracts that reward for greater numbers of covered lives. PMID:26625501

  7. Reducing the health care burden for marginalised migrants: The potential role for primary care in Europe.

    PubMed

    O'Donnell, Catherine Agnes; Burns, Nicola; Mair, Frances Susanne; Dowrick, Christopher; Clissmann, Ciaran; van den Muijsenbergh, Maria; van Weel-Baumgarten, Evelyn; Lionis, Christos; Papadakaki, Maria; Saridaki, Aristoula; de Brun, Tomas; MacFarlane, Anne

    2016-05-01

    There is a growing interest in the health of migrants worldwide. Migrants, particularly those in marginalised situations, face significant barriers and inequities in entitlement and access to high quality health care. This study aimed to explore the potential role of primary care in mitigating such barriers and identify ways in which health care policies and systems can influence the ability of primary care to meet the needs of vulnerable and marginalised migrants. The study compared routinely available country-level data on health system structure and financing, policy support for language and communication, and barriers and facilitators to health care access reported in the published literature. These were then mapped to a framework of primary care systems to identify where the key features mitigating or amplifying barriers to access lay. Reflecting on the data generated, we argue that culturally-sensitive primary care can play a key role in delivering accessible, high-quality care to migrants in vulnerable situations. Policymakers and practitioners need to appreciate that both individual patient capacity, and the way health care systems are configured and funded, can constrain access to care and have a negative impact on the quality of care that practitioners can provide to such populations. Strategies to address these issues, from the level of policy through to practice, are urgently needed.

  8. Reducing the health care burden for marginalised migrants: The potential role for primary care in Europe.

    PubMed

    O'Donnell, Catherine Agnes; Burns, Nicola; Mair, Frances Susanne; Dowrick, Christopher; Clissmann, Ciaran; van den Muijsenbergh, Maria; van Weel-Baumgarten, Evelyn; Lionis, Christos; Papadakaki, Maria; Saridaki, Aristoula; de Brun, Tomas; MacFarlane, Anne

    2016-05-01

    There is a growing interest in the health of migrants worldwide. Migrants, particularly those in marginalised situations, face significant barriers and inequities in entitlement and access to high quality health care. This study aimed to explore the potential role of primary care in mitigating such barriers and identify ways in which health care policies and systems can influence the ability of primary care to meet the needs of vulnerable and marginalised migrants. The study compared routinely available country-level data on health system structure and financing, policy support for language and communication, and barriers and facilitators to health care access reported in the published literature. These were then mapped to a framework of primary care systems to identify where the key features mitigating or amplifying barriers to access lay. Reflecting on the data generated, we argue that culturally-sensitive primary care can play a key role in delivering accessible, high-quality care to migrants in vulnerable situations. Policymakers and practitioners need to appreciate that both individual patient capacity, and the way health care systems are configured and funded, can constrain access to care and have a negative impact on the quality of care that practitioners can provide to such populations. Strategies to address these issues, from the level of policy through to practice, are urgently needed. PMID:27080344

  9. Establishment of primary health care in Vietnam.

    PubMed

    Birt, C A

    1990-08-01

    Basic demographic and epidemiological data relevant to health problems in Vietnam are described in this paper. Existing health service arrangements are referred to, with particular emphasis on the strategy for development of primary health care. The establishment of the paediatric centre in Ho Chi Minh City is reported, and examples of its valuable work in primary health care development are described.

  10. Teaching Primary Health Care: An Interdisciplinary Approach.

    ERIC Educational Resources Information Center

    Bezzina, Paul; Keogh, Johann J.; Keogh, Mariana

    1998-01-01

    Nursing and radiology students (n=15) at the University of Malta who completed an interdisciplinary module on primary health care reported they found the theoretical material applicable to practice; the module enabled them to learn about their potential role in primary health care. (SK)

  11. Describing Primary Care Encounters: The Primary Care Network Survey and the National Ambulatory Medical Care Survey

    PubMed Central

    Binns, Helen J.; Lanier, David; Pace, Wilson D.; Galliher, James M.; Ganiats, Theodore G.; Grey, Margaret; Ariza, Adolfo J.; Williams, Robert

    2007-01-01

    PURPOSE The purpose of this study was to describe clinical encounters in primary care research networks and compare them with those of the National Ambulatory Medical Care Survey (NAMCS). METHODS Twenty US primary care research networks collected data on clinicians and patient encounters using the Primary Care Network Survey (PRINS) Clinician Interview (PRINS-1) and Patient Record (PRINS-2), which were newly developed based on NAMCS tools. Clinicians completed a PRINS-1 about themselves and a PRINS-2 for each of 30 patient visits. Data included patient characteristics; reason for the visit, diagnoses, and services ordered or performed. We compared PRINS data with data obtained from primary care physicians during 5 cycles of NAMCS (1997–2001). Data were weighted; PRINS reflects participating networks and NAMCS provides national estimates. RESULTS By discipline, 89% of PRINS clinicians were physicians, 4% were physicians in residency training, 5% were advanced practice nurses/nurse-practitioners, and 2% were physician’s assistants. The majority (53%) specialized in pediatrics (34% specialized in family medicine, 9% in internal medicine, and 4% in other specialties). All NAMCS clinicians were physicians, with 20% specializing in pediatrics. When NAMCS and PRINS visits were compared, larger proportions of PRINS visits involved preventive care and were made by children, members of minority racial groups, and individuals who did not have private health insurance. A diagnostic or other assessment service was performed for 99% of PRINS visits and 76% of NAMCS visits (95% confidence interval, 74.9%–78.0%). A preventive or counseling/education service was provided at 64% of PRINS visits and 37% of NAMCS visits (95% confidence interval, 35.1%–38.0%). CONCLUSIONS PRINS presents a view of diverse primary care visits and differs from NAMCS in its methods and findings. Further examinations of PRINS data are needed to assess their usefulness for describing encounters that

  12. Costs of coordinated versus uncoordinated care in Germany: results of a routine data analysis in Bavaria

    PubMed Central

    Schneider, Antonius; Donnachie, Ewan; Tauscher, Martin; Gerlach, Roman; Maier, Werner; Mielck, Andreas; Linde, Klaus; Mehring, Michael

    2016-01-01

    Objectives The efficiency of a gatekeeping system for a health system, as in Germany, remains unclear particularly as access to specialist ambulatory care is not restricted. The aim was to compare the costs of coordinated versus uncoordinated patients (UP) in ambulatory care; with additional subgroup analysis of patients with mental disorders. Design Retrospective routine data analysis of patients with statutory health insurance, using claims data held by the Bavarian Association of Statutory Health Insurance Physicians. A patient was defined as uncoordinated if he or she visited at least 1 specialist without a referral from a general practitioner within a quarter. Outcomes were compared with propensity score matching analysis. Participants The study encompassed all statutorily insured patients in Bavaria contacting at least 1 ambulatory specialist in the first quarter of 2011 (n=3 616 510). Primary and secondary outcome measures Primary outcome was total costs of ambulatory care; secondary outcomes were financial claims of general physicians, specialists and for medication. Results The average age was 55.3 years for coordinated patients (CP, n=1 629 302), 48.3 years for UP (n=1 825 840). CP more frequently had chronic diseases (85.4%) as compared with UP (67.5%). The total unadjusted financial claim per patient was higher for UP (€234.52) than for CP (€224.41); the total adjusted difference was −€9.65 (95% CI −11.64 to −7.67), indicating lower costs for CP. The cost differences increased with increasing age. Total adjusted difference per patient with mental diseases as documented with an International Classification of Diseases (ICD)-10 F-diagnosis, was −€20.31 (95% CI −26.43 to −14.46). Conclusions Coordination of care is associated with lower ambulatory healthcare expenditures and is of particular importance for patients who are more vulnerable to medical interventions, especially for elderly and patients with mental disorders

  13. Primary Health Care and Narrative Medicine

    PubMed Central

    Murphy, John W

    2015-01-01

    Primary health care has received a lot of attention since the Alma Ata Conference, convened by the World Health Organization in 1978. Key to the strategy to improve health care outlined at the Alma Ata conference is citizen participation in every phase of service delivery. Although the goals of primary health care have not been achieved, the addition of narrative medicine may facilitate these ends. But a new epistemology is necessary, one that is compatible with narrative medicine, so that local knowledge is elevated in importance and incorporated into the planning, implementation, and evaluation of health programs. In this way, relevant, sustainable, and affordable care can be provided. The aim of this article is to discuss how primary health care might be improved through the introduction of narrative medicine into planning primary health care delivery. PMID:26222094

  14. African Primary Care Research: Quality improvement cycles

    PubMed Central

    Mash, Bob

    2014-01-01

    Abstract Improving the quality of clinical care and translating evidence into clinical practice is commonly a focus of primary care research. This article is part of a series on primary care research and outlines an approach to performing a quality improvement cycle as part of a research assignment at a Masters level. The article aims to help researchers design their quality improvement cycle and write their research project proposal. PMID:26245438

  15. Primary Mental Health Care in the Americas.

    ERIC Educational Resources Information Center

    Lima, Bruno R.

    This paper outlines selected differences between the United States and Latin America health care systems as they relate to primary mental health care. It notes that historically both the United States and Latin America have relied on custodial psychiatric hospitals. The alternative of community care for psychiatric patients is described as it is…

  16. 76 FR 61103 - Medicare Program; Comprehensive Primary Care Initiative

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-03

    ... HUMAN SERVICES Centers for Medicare & Medicaid Services Medicare Program; Comprehensive Primary Care... announces a solicitation for health care payer organizations to participate in the Comprehensive Primary Care initiative (CPC), a multipayer model designed to improve primary care. DATES: Letter of...

  17. Uncommon Caring: Primary Males and Implicit Judgments.

    ERIC Educational Resources Information Center

    King, James R.

    The caring and nurturing of children, which characterize primary education culture, have tended to shape a public perception of primary teaching as "women's work." Several social factors influence men's underrepresentation in the profession of primary education, such as parents not wanting their children exposed to "soft" males. Male primary…

  18. Substitution of Hospital Care with Primary Care: Defining the Conditions of Primary Care Plus

    PubMed Central

    Kroese, Mariëlle Elisabeth Aafje Lydia; Spreeuwenberg, Marieke Dingena; Elissen, Arianne Mathilda Josephus; Meerlo, Ronald Johan; Hanraets, Monique Margaretha Henriëtte; Ruwaard, Dirk

    2016-01-01

    Objective: To analyse barriers and facilitators in substituting hospital care with primary care to define preconditions for successful implementation. Methods: A descriptive feasibility study was performed to collect information on the feasibility of substituting hospital care with primary care. General practitioners were able to refer patients, about whom they had doubts regarding diagnosis, treatment and/or the need to refer to hospital care, to medical specialists who performed low-complex consultations at general practitioner practices. Qualitative data were collected through interviews with general practitioners and medical specialists, focus groups and notes from meetings in the Netherlands between April 2013 and January 2014. Data were analysed using a conventional content analysis which resulted in categorised barriers, facilitators and policy adjustments, after which preconditions were formulated. Results: The most important preconditions were make arrangements on governmental level, arrange a collective integrated IT-system, determine the appropriate profile for medical specialists, design a referral protocol for eligible patients, arrange deliberation possibilities for general practitioners and medical specialists and formulate a diagnostic protocol. Conclusions: The barriers, facilitators and formulated preconditions provided relevant input to change the design of substituting hospital care with primary care.

  19. Primary care and public emergency department overcrowding.

    PubMed Central

    Grumbach, K; Keane, D; Bindman, A

    1993-01-01

    OBJECTIVES. Our objective was to evaluate whether referral to primary care settings would be clinically appropriate for and acceptable to patients waiting for emergency department care for nonemergency conditions. METHODS. We studied 700 patients waiting for emergency department care at a public hospital. Access to alternative sources of medical care, clinical appropriateness of emergency department use, and patients' willingness to use nonemergency services were measured and compared between patients with and without a regular source of care. RESULTS. Nearly half (45%) of the patients cited access barriers to primary care as their reason for using the emergency department. Only 13% of the patients waiting for care had conditions that were clinically appropriate for emergency department services. Patients with a regular source of care used the emergency department more appropriately than did patients without a regular source of care. Thirty-eight percent of the patients expressed a willingness to trade their emergency department visit for an appointment with a physician within 3 days. CONCLUSIONS. Public emergency departments could refer large numbers of patients to appointments at primary care facilities. This alternative would be viable only if the availability and coordination of primary care services were enhanced for low-income populations. PMID:8438975

  20. Physical activity assessed in routine care predicts mortality after a COPD hospitalisation

    PubMed Central

    Moy, Marilyn L.; Gould, Michael K.; Liu, In-Lu Amy; Lee, Janet S.

    2016-01-01

    The independent relationship between physical inactivity and risk of death after an index chronic obstructive pulmonary disease (COPD) hospitalisation is unknown. We conducted a retrospective cohort study in a large integrated healthcare system. Patients were included if they were hospitalised for COPD between January 1, 2011 and December 31, 2011. All-cause mortality in the 12 months after discharge was the primary outcome. Physical activity, expressed as self-reported minutes of moderate to vigorous physical activity (MVPA), was routinely assessed at outpatient visits prior to hospitalisation. 1727 (73%) patients were inactive (0 min of MVPA per week), 412 (17%) were insufficiently active (1–149 min of MVPA per week) and 231 (10%) were active (≥150 min of MVPA per week). Adjusted Cox regression models assessed risk of death across the MVPA categories. Among 2370 patients (55% females and mean age 73±11 years), there were 464 (20%) deaths. Patients who were insufficiently active or active had a 28% (adjusted HR 0.72 (95% CI 0.54–0.97), p=0.03) and 47% (adjusted HR 0.53 (95% CI 0.34–0.84), p<0.01) lower risk of death, respectively, in the 12 months following an index COPD hospitalisation compared to inactive patients. Any level of MVPA is associated with lower risk of all-cause mortality after a COPD hospitalisation. Routine assessment of physical activity in clinical care would identify persons at high risk for dying after COPD hospitalisation. PMID:27730174

  1. Integrated Care at the Interface of Psychiatry and Primary Care: Prevention of Cardiovascular Disease.

    PubMed

    McCarron, Robert M

    2015-09-01

    Patients with mental illness, particularly serious mental illness, are more likely to suffer from common disorders without optimal treatment. Changes in preventive practice patterns cannot be fully realized on a large scale until clinicians are trained how to routinely provide this care. Psychiatrists may consider using preventive care strategies in the area of cardiovascular health, as cardiovascular disease is the most common cause of death and disproportionately affects patients with mental illness. At minimum, psychiatrists are well positioned to work collaboratively with primary care providers to address psychopathology that may interfere with adherence to the treatment plan. PMID:26300033

  2. Primary care and genetics and genomics.

    PubMed

    Scott, Joan; Trotter, Tracy

    2013-12-01

    With the recent expansion of genetic science, its evolving translation to clinical medicine, and the growing number of available resources for genomics in primary care, the primary care provider must increasingly integrate genetics and genomics into daily practice. Because primary care medicine combines the treatment of acute illness with disease prevention and anticipatory guidance, the primary care provider is in an ideal position to evaluate and treat patients for genetic disease. The notion that genetic knowledge is only rarely needed will have to be replaced with a comprehensive approach that integrates "genetic thinking" into every patient encounter. Genomic competencies will need to be added to the primary care provider's repertoire; such competencies include prevention, assessment, evaluation, and diagnosis of genetic conditions; the ordering and interpreting of genetic tests; communication with families; appropriate referrals; and the management or comanagement of care. The process of deciding when to order genetic tests, what tests to order, and how to interpret the results is complex, and the tests and their results have specific risks and benefits, especially for pediatric patients. The longitudinal nature of primary pediatric care provides the opportunity to obtain and continually update the family history, which is the most powerful initial genetic "test." The ongoing provider-family relationship, coupled with the astounding number of advances in genetic and genomic testing, also necessitates a constant re-evaluation of past diagnosis or nondiagnosis.

  3. Depression in primary care in Israel.

    PubMed

    Geulayov, Galit; Lipsitz, Joshua; Sabar, Ron; Gross, Raz

    2007-08-01

    Depression is a leading cause of morbidity, disability and health care utilization. It is commonly encountered in primary care settings yet is often missed or suboptimally managed. We summarize studies conducted in Israel on the prevalence of depression in primary care settings, its correlates, and predictors of treatment and outcome, and discuss their implications for clinical practice and public health policy. An electronic search was conducted using the MEDLINE and PsychINFO databases. The inclusion criteria were original studies that assessed aspects of depression in a population aged 18 or older, were conducted in primary care settings in Israel, and had sufficient detailed description of depression-related measures, study sample and outcome measures. Twelve articles reporting results from seven studies met these criteria. The prevalence of current depression in primary care varied considerably across studies: 1.6-5.9% for major depression, 1.1-5.4% for minor depression, 14.3-24% for depressive symptoms. Depression was consistently related to female gender and fewer years of education, and was associated with disability, decreased quality of life, and increased health-related expenditure. Many cases of depression were undiagnosed and most patients had persistent depression or achieved only partial remission. Depression represents a serious challenge for the primary health care system in Israel. Greater efforts should be focused on screening and treating depression in primary care. However, the studies reviewed here used different methodologies and assessed different aspects of depression and, therefore, should be generalized cautiously. Systematic research on the prevalence, correlates and management of depression in primary care, with emphasis on collaborative care models, is strongly needed to inform research, clinicians and health care policy makers. PMID:17877061

  4. [Primary health care physician in modern conditions].

    PubMed

    Cindrić, Jasna

    2007-02-01

    Some basic considerations about the role and responsibilities of primary health care physician are presented. The attitude towards the patient and other activities of general practitioners are described. Rational, multidisciplinary and multifactorial dialogues and cooperation with other colleagues is also stressed. Team work and collaboration with other segments involved in the patient health care is an imperative. Working conditions are not equal in all health care settings, however, all health care personnel, regardless of their place of work, must implement rationalization of health care expenses and keep high professional level in urban and rural settings, even those distant from large medical centers. The possible misunderstandings of professional interests that can be destructive for working atmosphere are also mentioned. Primary health care is the cheapest and economically most efficient type of health care for a particular population. In this context, primary health care physicians/family doctors find their role and responsibilities, follow organizational principles, system and methods of work. To conclude, a more positive potential of primary health care and its affirmation is stressed.

  5. Optimising primary care for people with dementia

    PubMed Central

    2013-01-01

    This review considers key areas in primary care regarding the diagnosis of dementia. Issues surrounding assessment, policy and incentives are considered. In addition, the relevance of non-medication approaches for dementia in primary care, which aim to enhance or maintain quality of life by maximising psychological and social function in the context of existing disabilities, is deliberated. Finally, key issues about primary care medication management are considered, and relevant therapeutic strategies with recommendation for a collaborative approach that improve outcomes by linking primary and secondary healthcare services – including general practice and pharmacy – with social care needs are weighed up. A key aspect of such a collaborative approach is to support informal carers in optimising medication. PMID:24427181

  6. Integrated Primary Care Information Database (IPCI)

    Cancer.gov

    The Integrated Primary Care Information Database is a longitudinal observational database that was created specifically for pharmacoepidemiological and pharmacoeconomic studies, inlcuding data from computer-based patient records supplied voluntarily by general practitioners.

  7. Everyday Routines: A Window into the Cultural Organization of Family Child Care

    ERIC Educational Resources Information Center

    Tonyan, Holli A.

    2015-01-01

    Eco(logical)-cultural Theory suggests that a daily routine results from individuals adapting cultural ideas to the constraints of a local context or ecology. Using Ecocultural Theory, this research examined family child care providers' descriptions of daily activities and overall approach to understand cultural models. The results highlighted a…

  8. Provider satisfaction in army primary care clinics.

    PubMed

    Byers, V L; Mays, M Z; Mark, D D

    1999-02-01

    The job satisfaction of physicians, nurse practitioners, and physician assistants was assessed during the course of a multicenter study of Army primary care clinics. All providers in nine clinics at three medical centers who were engaged in adult or family care were invited to participate in the study. Questionnaires on job satisfaction and other practice style variables were completed by 26 physicians, 19 nurse practitioners, and 13 physician assistants (46, 76, and 41% of eligible providers, respectively). Analysis revealed a broad range of job satisfaction in the sample. However, average levels of job satisfaction were not significantly different across the three groups of primary care providers. Autonomy and collaboration were significant predictors of job satisfaction. It is clear that changes in health care systems that reduce, or appear to reduce, the primary care provider's autonomy in clinical matters are likely to reduce provider satisfaction as well. PMID:10050571

  9. Primary care teams: New Zealand's experience with community-governed non-profit primary care.

    PubMed

    Crampton, Peter; Davis, Peter; Lay-Yee, Roy

    2005-05-01

    Community-governed non-profit primary care organisations started developing in New Zealand in the late 1980s with the aim to reduce financial, cultural and geographical barriers to access. New Zealand's new primary health care strategy aims to co-ordinate primary care and public health strategies with the overall objective of improving population health and reducing health inequalities. The purpose of this study is to carry out a detailed examination of the composition and characteristics of primary care teams in community-governed non-profit practices and compare them with more traditional primary care organisations, with the aim of drawing conclusions about the capacity of the different structures to carry out population-based primary care. The study used data from a representative national cross-sectional survey of general practitioners in New Zealand (2001/2002). Primary care teams were largest and most heterogeneous in community-governed non-profit practices, which employed about 3% of the county's general practitioners. Next most heterogeneous in terms of their primary care teams were practices that belonged to an Independent Practitioner Association, which employed the majority of the country's general practitioners (71.7%). Even though in absolute and relative terms the community-governed non-profit primary care sector is small, by providing a much needed element of professional and organisational pluralism and by experimenting with more diverse staffing arrangements, it is likely to continue to have an influence on primary care policy development in New Zealand.

  10. A New Path to Primary Care.

    PubMed

    Sorrel, Amy Lynn

    2016-03-01

    The University of North Texas Health Science Center and the Texas College of Osteopathic Medicine are partnering with Midland College and Midland Memorial Hospital to keep their own crop of future doctors in the area. The Primary Care Pathway identifies interested, high-achieving community college students likely to be successful in medical school and guarantees them an accelerated pathway to a doctor of osteopathic medicine degree, focusing earlier and more intensely on primary care. PMID:26928815

  11. A New Path to Primary Care.

    PubMed

    Sorrel, Amy Lynn

    2016-03-01

    The University of North Texas Health Science Center and the Texas College of Osteopathic Medicine are partnering with Midland College and Midland Memorial Hospital to keep their own crop of future doctors in the area. The Primary Care Pathway identifies interested, high-achieving community college students likely to be successful in medical school and guarantees them an accelerated pathway to a doctor of osteopathic medicine degree, focusing earlier and more intensely on primary care.

  12. Root doctors as providers of primary care.

    PubMed

    Stitt, V J

    1983-07-01

    Physicians in primary care recognize that as many as 65 percent of the patients seen in their offices are there for psychological reasons. In any southern town with a moderate population of blacks, there are at least two "root doctors." These root doctors have mastered the power of autosuggestion and are treating these patients with various forms of medication and psychological counseling. This paper updates the practicing physician on root doctors who practice primary care.

  13. Root Doctors as Providers of Primary Care

    PubMed Central

    Stitt, Van J.

    1983-01-01

    Physicians in primary care recognize that as many as 65 percent of the patients seen in their offices are there for psychological reasons. In any southern town with a moderate population of blacks, there are at least two “root doctors.” These root doctors have mastered the power of autosuggestion and are treating these patients with various forms of medication and psychological counseling. This paper updates the practicing physician on root doctors who practice primary care. PMID:6887277

  14. Exploring primary care activities in ACT teams.

    PubMed

    Vanderlip, Erik R; Williams, Nancy A; Fiedorowicz, Jess G; Katon, Wayne

    2014-05-01

    People with serious mental illness often receive inadequate primary and preventive care services. Federal healthcare reform endorses team-based care that provides high quality primary and preventive care to at risk populations. Assertive community treatment (ACT) teams offer a proven, standardized treatment approach effective in improving mental health outcomes for the seriously mentally ill. Much is known about the effectiveness of ACT teams in improving mental health outcomes, but the degree to which medical care needs are addressed is not established. The purpose of this study was to explore the extent to which ACT teams address the physical health of the population they serve. ACT team leaders were invited to complete an anonymous, web-based survey to explore attitudes and activities involving the primary care needs of their clients. Information was collected regarding the use of health screening tools, physical health assessments, provision of medical care and collaboration with primary care systems. Data was analyzed from 127 team leaders across the country, of which 55 completed the entire survey. Nearly every ACT team leader believed ACT teams have a role in identifying and managing the medical co-morbidities of their clientele. ACT teams report participation in many primary care activities. ACT teams are providing a substantial amount of primary and preventive services to their population. The survey suggests standardization of physical health identification, management or referral processes within ACT teams may result in improved quality of medical care. ACT teams are in a unique position to improve physical health care by virtue of having medically trained staff and frequent, close contact with their clients.

  15. Caring for patients with melanoma in the primary care setting.

    PubMed

    Rea, Mary; Perrino, Laura; Sheets, Victoria; McDaniel, M Jane

    2014-07-01

    The incidence of melanoma is steadily rising and mortality continues to increase. This article describes types of melanoma and the role of primary care providers in the long-term management and follow-up of patients diagnosed with melanoma.

  16. Primary Care in Secondary Settings: Inherent Strains

    ERIC Educational Resources Information Center

    Maier, Henry W.; Garfat, Thom

    2005-01-01

    There is an ever present struggle associated with reconciling "primary" care requirements for children and young people living in group care programs with "secondary" organizational demands imposed by external agency expectations and administrative requirements. That struggle finds its expression and potential balance in the daily work of staff.…

  17. Millennial transformation for primary care.

    PubMed

    Cowan, Michael

    2010-06-01

    We do not need a crystal ball to see the future. Our web-based future has already arrived in all other aspects of our lives--even our mobile phones. The tools for progress--Personal Health Records, Social Networks, and Online medical information--are widely available. The demand is at hand--Millennials are flexing consumer muscles as they enter the healthcare market. Real "Health Care Reform" requires fundamental changes in practice--which in turn requires effective use of information technologies and adaption to changing consumer expectations. The VHA and the MHS are uniquely capable of leveraging political, academic and technological forces to help move American health care through this millennial transformation. Federal health systems are positioned to demonstrate the value of innovation as America seeks healthcare reform. PMID:20572466

  18. Millennial transformation for primary care.

    PubMed

    Cowan, Michael

    2010-06-01

    We do not need a crystal ball to see the future. Our web-based future has already arrived in all other aspects of our lives--even our mobile phones. The tools for progress--Personal Health Records, Social Networks, and Online medical information--are widely available. The demand is at hand--Millennials are flexing consumer muscles as they enter the healthcare market. Real "Health Care Reform" requires fundamental changes in practice--which in turn requires effective use of information technologies and adaption to changing consumer expectations. The VHA and the MHS are uniquely capable of leveraging political, academic and technological forces to help move American health care through this millennial transformation. Federal health systems are positioned to demonstrate the value of innovation as America seeks healthcare reform.

  19. [Antiseptic use in primary care].

    PubMed

    Gutiérrez Pérez, M Isabel; Lucio-Villegas Menéndez, M Eulalia; González, Laura López; Lluch, Natalia Aresté; Morató Agustí, M Luisa; Cachafeiro, Santiago Pérez

    2014-05-01

    Wounds can be classified according to their mechanism of action into surgical or traumatic (which may be incision wounds, such as those provoked by a sharp object; contusions, caused by a blunt force; puncture wounds, caused by long, sharp objects; lacerations, caused by tears to the tissue; or bites, which have a high risk of infection and consequently should not be sutured). Wounds can also be classified by their healing process into acute or chronic (pressure ulcers, vascular ulcers, neuropathic ulcers, acute wounds with torpid clinical course). The use of antiseptics in any of these wounds is usually limited to cleaning and initial care -up to 48 hours- and to washing of hands and instruments. The use of antiseptics in chronic or persistent wounds is more debatable. The same is true of burns, in which the use of formulations that encourage hydration is recommended. In the pediatric population, the use of antiseptics with a known safety profile and low absorption is usually recommended, especially in the care of the umbilical cord, in which evidence supports the use of chlorhexidine gluconate. Another use of antiseptics is the care of wounds produced by procedures used in body esthetics, such as piercings; in these procedures, it is advisable to use transparent antiseptics that allow visualization of the technique.

  20. Geriatric depression assessment by rural primary care physicians

    PubMed Central

    Glasser, M; Vogels, L; Gravdal, J

    2013-01-01

    Introduction Depression is the fourth leading cause of the global disease burden, and approximately one in four elderly people may suffer from depression or depressive symptoms. Depression in later life is generally regarded as highly treatable, but under-treatment is still common in this population, especially among those in rural areas where access to healthcare is often an issue. In this study rural primary care physicians’ practices, attitudes, barriers and perceived needs in the diagnosis and treatment of geriatric depression were described, and trends in care delivery examined. Methods A survey was sent to 162 rural Illinois family physicians and general internists. The survey focused on current practices, attitudes and perceptions regarding geriatric depression, barriers to and needs for improvement in depression care and physician and practice characteristics. Results Seventy-six physicians (47%) responded. The rural physicians indicated that over one-third of their patients aged 60 years and older were depressed. All reported routine screening for depression, with 24% using the Beck Depression Inventory. Overall, physicians expressed positive attitudes about their involvement in treating older depressed patients. However, 45% indicated a ‘gap’ between ideal and available care in their rural practices. Physicians with higher proportions of elderly patients in their panels were more likely to feel that more training in residency in geriatric care would be helpful in improving care, and that better availability of psychologists and counselors would be important for improvement of care for older, depressed patients. Conclusions This study responds to recent calls to better understand how primary care physicians diagnose and treat depression in older adults. Generally, primary care physicians appear comfortable and prepared in depression diagnosis and management, but factors such as availability of appropriate care remain a challenge. PMID:19929129

  1. Effectiveness and predictors of outcome in routine out-patient mental health care for older adults.

    PubMed

    Veerbeek, Marjolein A; Oude Voshaar, Richard C; Pot, Anne Margriet

    2014-04-23

    ABSTRACT Background: Meta-analyses show efficacy of several psychological and pharmacological interventions for late-life psychiatric disorders, but generalization of effects to routine mental health care for older people remains unknown. Aim of this study is to investigate the improvement of functioning within one year of referral to an outpatient mental health clinic for older adults. Methods: Pre-post measurement of the Health of Nations Outcome Scale 65+ (HoNOS 65+) in 704 older people referred for psychiatric problems (no dementia) to any of the seven participating mental health care organizations. Results: The pre-post-test Cohen's d effect size was 1.08 in the total group and 1.23 in depressed patients, the largest subgroup. Linear regression identified better functioning at baseline, comorbid personality disorder, somatic comorbidity and life events during treatment as determinants of a worse outcome. Conclusions: Functioning of older persons with psychiatric problems largely improves after treatment in routine mental health care.

  2. Eating Disorders in the Primary Care Setting.

    PubMed

    Sangvai, Devdutta

    2016-06-01

    Eating disorders are a complex set of illnesses most commonly affecting white adolescent girls and young women. The most common eating disorders seen in the primary care setting are anorexia nervosa, bulimia nervosa, and binge eating disorder. Treatment in the primary care environment ideally involves a physician, therapist, and nutritionist, although complex cases may require psychiatric and other specialist care. Early diagnosis and treatment are associated with improved outcomes, whereas the consequences of untreated eating disorders, particularly anorexia nervosa, can be devastating, including death. PMID:27262009

  3. Structured career pathways in academic primary care.

    PubMed

    Foy, Robbie; Eccles, Martin

    2008-02-01

    Research in primary care has much to offer researchers and ultimately efforts to improve population health and health care. There is a need for capacity building and efforts to improve the science of research in this field. This article outlines a relatively structured career pathway for primary care researchers and offers advice on opportunities and commonly encountered pitfalls. It is largely based upon the authors' experiences and personal reflections as medically trained researchers but many of the implications and lessons are relevant to other clinical and research disciplines.

  4. Primary Care Physicians' Dementia Care Practices: Evidence of Geographic Variation

    ERIC Educational Resources Information Center

    Fortinsky, Richard H.; Zlateva, Ianita; Delaney, Colleen; Kleppinger, Alison

    2010-01-01

    Purpose: This article explores primary care physicians' (PCPs) self-reported approaches and barriers to management of patients with dementia, with a focus on comparisons in dementia care practices between PCPs in 2 states. Design and Methods: In this cross-sectional study, questionnaires were mailed to 600 randomly selected licensed PCPs in…

  5. Approach to economic evaluation in primary care

    PubMed Central

    McBrien, Kerry A.; Manns, Braden

    2013-01-01

    Abstract Objective To present an overview of the methods of economic evaluation in health care, using examples of studies applicable to primary care. Sources of information The main concepts discussed in this article were derived from expert opinion and substantiated with well respected textbooks and comprehensive Canadian guidelines. Examples of cost-effectiveness estimates were taken from the published literature. Main message We describe the basic principles of economic evaluation and provide an introduction to its interpretation, using examples of studies applicable to primary care. Conclusion A basic understanding of health economics will allow primary care practitioners to begin to incorporate economic data, including that from economic evaluations when they are available, into resource planning for their practices. PMID:23766042

  6. Primary care--opportunities and threats. Developing prescribing in primary care.

    PubMed Central

    Bradley, C. P.; Taylor, R. J.; Blenkinsopp, A.

    1997-01-01

    The latest white papers on the NHS focus on stimulating innovation in the delivery of primary care and removing barriers to further development. Some of this innovation relates directly to prescribing in primary care, and in this article the authors speculate on what might happen if the prescribing initiatives referred to in the white papers were extended and disseminated more widely. The initiatives which might have the biggest impact are those encouraging closer collaboration between general practitioners and community pharmacists and those aiding extension of the current nurse prescribing scheme in primary care. Both offer considerable opportunities to improve primary care, but both bear some potential risks. PMID:9116557

  7. The ORIGINS of Primary Health Care and SELECTIVE Primary Health Care

    PubMed Central

    Cueto, Marcos

    2004-01-01

    I present a historical study of the role played by the World Health Organization and UNICEF in the emergence and diffusion of the concept of primary health care during the late 1970s and early 1980s. I have analyzed these organizations’ political context, their leaders, the methodologies and technologies associated with the primary health care perspective, and the debates on the meaning of primary health care. These debates led to the development of an alternative, more restricted approach, known as selective primary health care. My study examined library and archival sources; I cite examples from Latin America. PMID:15514221

  8. [Primary care in the United Kingdom].

    PubMed

    Sánchez-Sagrado, T

    2016-03-01

    The inadequate planning of health professionals in Spain has boosted the way out of doctors overseas. The United Kingdom is one of the countries chosen by Spanish doctors to develop their job. The National Health Service is a health system similar to the Spanish one. Health care services are financing mainly through taxes. The right to health care is linked to the citizen condition. The provision of health care is a mix-up of public and private enterprises. Primary Care is much closed to Spanish Primary Care. Doctors are "self-employed like" professionals. They can set their surgeries in a free area previously designed by the government. They have the right to make their own team and to manage their own budget. Medical salary is linked to professional capability and curriculum vitae. The main role of a General Practitioner is the prevention. Team work and coordination within primary and specialised care is more developed than in Spain. The access to diagnostic tests and to the specialist is controlled through waiting lists. General Practitioners work as gate-keepers. Patients may choose freely their doctor and consultations and hospital care are free at the point of use. Within the United Kingdom there are also health regions with problems due to inequalities to access and to treatment. There is a training path and the access to it is by Curricula. The number of training jobs is regulated by the local needs. Continuing education is compulsory and strictly regulated local and nationally. The National Health Service was the example for the Spanish health reform in 1986. While Spanish Primary health care is of quality, the efficiency of the health system would improve if staff in Primary Care settings were managed in a similar way to the British's.

  9. Primary health care use and health care accessibility among adolescents in the United Arab Emirates.

    PubMed

    Barakat-Haddad, C; Siddiqua, A

    2015-05-19

    This study examined primary health care use and accessibility among adolescents living in the United Arab Emirates. In a cross-sectional study, we collected health care use, sociodemographic and residential data for a sample of 6363 adolescents. Logistic regression modelling was used to examine predictors of health care use. The most-consulted health professionals were dentists or orthodontists, family doctors and eye specialists. Local adolescents were more likely to attend public clinics/hospitals than private facilities, while the opposite was true for expatriates. In the previous 12 months 22.6% of the participants had not obtained the health care they needed and 19.5% had not had a routine health check-up. Common reasons for not obtaining care were busy schedules, dislike/fear of doctors and long waiting times. Predictors of not obtaining needed care included nationality and income, while those for having a routine check-up were mother's education and car ownership. Improvements to the health care sector may increase health care accessibility among adolescents.

  10. Carrier screening in preconception consultation in primary care.

    PubMed

    Metcalfe, Sylvia A

    2012-07-01

    Discussing carrier screening during preconception consultation in primary care has a number of advantages in terms of promoting autonomy and enabling the greatest range of reproductive choices. For those with a family history of an inherited condition, this ought to be a routine discussion; however, this can be expanded to include the wider population, especially for those conditions for which carrier frequencies are considered relatively common. There is published literature from around the world regarding experiences with carrier screening in primary care for cystic fibrosis, haemoglobinopathies, fragile X syndrome, Tay-Sachs disease and spinal muscular atrophy, although many of these have tended to focus on consultations during rather than before pregnancy. Overall, these studies reveal that population carrier screening is well received by the participants with apparent minimal psychosocial harms; however, challenges exist in terms of approaches to ensure couples receive adequate information to make personally relevant decisions and for ongoing health professional engagement. PMID:22183783

  11. A Proposal for Electronic Medical Records in U.S. Primary Care

    PubMed Central

    Bates, David W.; Ebell, Mark; Gotlieb, Edward; Zapp, John; Mullins, H.C.

    2003-01-01

    Delivery of excellent primary care—central to overall medical care—demands that providers have the necessary information when they give care. This paper, developed by the National Alliance for Primary Care Informatics, a collaborative group sponsored by a number of primary care societies, argues that providers’ and patients’ information and decision support needs can be satisfied only if primary care providers use electronic medical records (EMRs). Although robust EMRs are now available, only about 5% of U.S. primary care providers use them. Recently, with only modest investments, Australia, New Zealand, and England have achieved major breakthroughs in implementing EMRs in primary care. Substantial benefits realizable through routine use of electronic medical records include improved quality, safety, and efficiency, along with increased ability to conduct education and research. Nevertheless, barriers to adoption exist and must be overcome. Implementing specific policies can accelerate utilization of EMRs in the U.S. PMID:12509352

  12. Brief Behavioral Interventions for Symptoms of Depression and Insomnia in University Primary Care

    ERIC Educational Resources Information Center

    Funderburk, Jennifer S.; Shepardson, Robyn L.; Krenek, Marketa

    2015-01-01

    Objective: To describe how behavioral activation (BA) for depression and stimulus control (SC) for insomnia can be modified to a brief format for use in a university primary care setting, and to evaluate preliminarily their effectiveness in reducing symptoms of depression and insomnia, respectively, using data collected in routine clinical care.…

  13. Diverticular Disease in the Primary Care Setting.

    PubMed

    Wensaas, Knut-Arne; Hungin, Amrit Pali

    2016-10-01

    Diverticular disease is a chronic and common condition, and yet the impact of diverticular disease in primary care is largely unknown. The diagnosis of diverticular disease relies on the demonstration of diverticula in the colon, and the necessary investigations are often not available in primary care. The specificity and sensitivity of symptoms, clinical signs and laboratory tests alone are generally low and consequently the diagnostic process will be characterized by uncertainty. Also, the criteria for symptomatic uncomplicated diverticular disease in the absence of macroscopic inflammation are not clearly defined. Therefore both the prevalence of diverticular disease and the incidence of diverticulitis in primary care are unknown. Current recommendations for treatment and follow-up of patients with acute diverticulitis are based on studies where the diagnosis has been verified by computerized tomography. The results cannot be directly transferred to primary care where the diagnosis has to rely on the interpretation of symptoms and signs. Therefore, one must allow for greater diagnostic uncertainty, and safety netting in the event of unexpected development of the condition is an important aspect of the management of diverticulitis in primary care. The highest prevalence of diverticular disease is found among older patients, where multimorbidity and polypharmacy is common. The challenge is to remember the possible contribution of diverticular disease to the patient's overall condition and to foresee its implications in terms of advice and treatment in relation to other diseases. PMID:27622376

  14. Homelessness: a problem for primary care?

    PubMed

    Riley, Anthony J; Harding, Geoffrey; Underwood, Martin R; Carter, Yvonne H

    2003-06-01

    Homelessness is a social problem that affects all facets of contemporary society. This paper discusses the concept of homelessness in terms of its historical context and the dominance of the pervasive 'victim blaming' ideologies, which, together with the worldwide economic changes that have contributed to a fiscal crisis of the state, and the resultant policies and circumstances, have led to an increase in the number of 'new homeless' people. This paper attempts to challenge the dominant political discourse on homelessness. The widespread healthcare problems and heterogeneity of homeless people have a particular impact on health services, with many homeless people inappropriately accessing local accident and emergency (A&E) departments because of barriers inhibiting adequate access to primary care. A number of primary care schemes have been successfully implemented to enable the homeless to have better access to appropriate care. However, there is no consistency in the level of services around the United Kingdom (UK), and innovations in service are not widespread and by their nature they are ad hoc. Despite the successes of such schemes, many homeless people still access health care inappropriately. Until homeless people are fully integrated into primary care the situation will not change. The question remains, how can appropriate access be established? A start can be made by building on some of the positive work that is already being done in primary care, but in reality general practitioners (GPs) will be 'swimming against the tide' unless a more integrated policy approach is adopted to tackle homelessness. PMID:12939894

  15. Large Independent Primary Care Medical Groups

    PubMed Central

    Casalino, Lawrence P.; Chen, Melinda A.; Staub, C. Todd; Press, Matthew J.; Mendelsohn, Jayme L.; Lynch, John T.; Miranda, Yesenia

    2016-01-01

    PURPOSE In the turbulent US health care environment, many primary care physicians seek hospital employment. Large physician-owned primary care groups are an alternative, but few physicians or policy makers realize that such groups exist. We wanted to describe these groups, their advantages, and their challenges. METHODS We identified 21 groups and studied 5 that varied in size and location. We conducted interviews with group leaders, surveyed randomly selected group physicians, and interviewed external observers—leaders of a health plan, hospital, and specialty medical group that shared patients with the group. We triangulated responses from group leaders, group physicians, and external observers to identify key themes. RESULTS The groups’ physicians work in small practices, with the group providing economies of scale necessary to develop laboratory and imaging services, health information technology, and quality improvement infrastructure. The groups differ in their size and the extent to which they engage in value-based contracting, though all are moving to increase the amount of financial risk they take for their quality and cost performance. Unlike hospital-employed and multispecialty groups, independent primary care groups can aim to reduce health care costs without conflicting incentives to fill hospital beds and keep specialist incomes high. Each group was positively regarded by external observers. The groups are under pressure, however, to sell to organizations that can provide capital for additional infrastructure to engage in value-based contracting, as well as provide substantial income to physicians from the sale. CONCLUSIONS Large, independent primary care groups have the potential to make primary care attractive to physicians and to improve patient care by combining human scale advantages of physician autonomy and the small practice setting with resources that are important to succeed in value-based contracting. PMID:26755779

  16. Rainbows: a primary health care initiative for primary schools.

    PubMed

    Munns, Ailsa; Forde, Karen A; Krouzecky, Miriam; Shields, Linda

    2015-01-01

    Within the current Australian health system is the understanding of a need to change from the predominate biomedical model to incorporate a comprehensive primary health care centred approach, embracing the social contexts of health and wellbeing. Recent research investigated the benefits of the primary health care philosophy and strategies in relation to the Rainbows programme which addresses grief and loss in primary school aged students in Western Australia. A multidisciplinary collaboration between the Western Australian Departments of Health and Education enabled community school health nurse coordinators to train teacher facilitators in the implementation of Rainbows, enabling support for students and their parents. The results of this qualitative study indicate that all participants regard Rainbows as effective, with many perceived benefits to students and their families. PMID:26281402

  17. The Geriatrics in Primary Care Demonstration: Integrating Comprehensive Geriatric Care into the Medical Home: Preliminary Data.

    PubMed

    Engel, Peter A; Spencer, Jacqueline; Paul, Todd; Boardman, Judith B

    2016-04-01

    Three thousand nine hundred thirty-one veterans aged 75 and older receive primary care (PC) in two large practices of the Department of Veterans Affairs (VA) Boston Healthcare System. Cognitive and functional disabilities are endemic in this group, creating needs that predictably exceed available or appropriate resources. To address this problem, Geriatrics in Primary Care (GPC) embeds geriatric services directly into primary care. An on-site consulting geriatrician and geriatric nurse care manager work directly with PC colleagues in medicine, nursing, social work, pharmacy, and mental health within the VA medical home. This design delivers interdisciplinary geriatric care within PC that emphasizes comprehensive evaluations, care management, planned transitions, informed resource use, and a shift in care focus from multiple subspecialties to PC. Four hundred thirty-five veterans enrolled during the project's 4-year course. Complex, fragmented care was evident in a series of 50 individuals (aged 82 ± 7) enrolled during Months 1 to 6. The year before, these individuals made 372 medical or surgical subspecialty clinic visits (7.4 ± 9.8); 34% attended five or more subspecialty clinics, 48% had dementia, and 18% lacked family caregivers. During the first year after enrollment the mean number of subspecialty clinic visits declined significantly (4.7 ± 5.0, P = .01), whereas the number of PC-based visits remained stable (3.1 ± 1.5 and 3.3 ± 1.5, respectively, P = .50). Telephone contact by GPC (2.3 ± 2.0) and collaboration with PC clinicians replaced routine follow-up geriatric care. GPC facilitated planned transitions to rehabilitation centers (n = 5), home hospice (n = 2), dementia units (n = 3), and home care (n = 37). GPC provides efficient, comprehensive geriatric care and case management while preserving established relationships between patients and the PC team. Preliminary results suggest "care defragmentation," as reflected by a significant reduction in

  18. The Teamlet Model of Primary Care

    PubMed Central

    Bodenheimer, Thomas; Laing, Brian Yoshio

    2007-01-01

    The 15-minute visit does not allow the physician sufficient time to provide the variety of services expected of primary care. A teamlet (little team) model of care is proposed to extend the 15-minute physician visit. The teamlet consists of 1 clinician and 2 health coaches. A clinical encounter includes 4 parts: a previsit by the coach, a visit by the clinician together with the coach, a postvisit by the coach, and between-visit care by the coach. Medical assistants or other practice personnel would require retraining to assume the health coach role. Some organizations have instituted aspects of the teamlet model. Primary care practices interested in trying out the teamlet concept need to train 2 health coaches for each full-time equivalent clinician to ensure smooth patient flow. PMID:17893389

  19. Cardiovascular Collapse Associated With Irreversible Cardiomyopathy, Chronic Renal Failure, and Hypertension During Routine Dental Care

    PubMed Central

    Thoms, Sean; Cooke, Matthew; Crawford, James

    2016-01-01

    Patients with multiple comorbid conditions visit the dental office every day, and although rare, complications from their conditions may occur during treatment. A case is presented of a 65-year-old African American woman with a history of severe cardiovascular disease, renal disease, and a reported local anesthetic allergy who experienced complete cardiovascular collapse during routine dental treatment from which she was successfully resuscitated. Treating clinicians should recognize the emerging symptoms and be proficient with a basic and advanced cardiac life support protocol to care for their patients safely and effectively until they can be transported to more advanced care facilities. PMID:26866410

  20. The role of the primary care physician in caring for patients with type-1 diabetes.

    PubMed

    Van Meter, Q L

    1998-02-01

    The management of type-1 diabetic patients is a challenge. Given the natural frequency of this medical problem, most primary care providers will have such patients in their office-based practice. The push for tighter control in order to lessen long-term complications is a sensible move, but it does not inherently require that you absent yourself from the loop. Most of the hoopla from the DCCT study has been used to justify the role of the endocrine sub-specialty team in the "primary care" management of all diabetic patients so that third-party payers will continue to fund such care as routine. While such team management has clear benefits, it should not preclude your active involvement in day-to-day management for fear that you do not have the proper credentials. Hopefully, this overview will give you the confidence to jump back in the ring. PMID:9533990

  1. [Management of psychological trauma in primary care].

    PubMed

    Figueroa, Rodrigo A; Cortés, Paula F; Accatino, Luigi; Sorensen, Richard

    2016-05-01

    Exposure to traumatic events is frequent in the general population and psychiatric sequelae such as post-traumatic stress disorders are common. The symptoms of psychiatric sequelae after trauma are vague, with multiple psychological and physical symptoms, which can confuse the health care professional. This paper seeks to facilitate the work in primary care, providing practical information about the diagnosis, initial management and referral of patients who have suffered traumatic experiences. Some early interventions and treatments are suggested. PMID:27552016

  2. Marketplace reforms and primary care career decisions.

    PubMed

    Retchin, S M; Boling, P A; Nettleman, M D; Mick, S S

    2001-04-01

    A dramatic shift in the postgraduate career choices of medical school graduates toward primary care occurred during the mid-1990s. While some attributed this shift to changes in medical school curricula, perceptions stemming from marketplace reforms were probably responsible. For the most part, these perceptions were probably generated through informal communications among medical students and through the media. More recently, additional marketplace influences, such as the consumer backlash toward managed care and unrealized gains in primary care physicians' personal incomes, may have fostered contrasting perceptions among medical students, leading to career choices away from primary care, particularly family practice. The authors offer two recommendations for enhancing the knowledge of medical students concerning workforce supply and career opportunities: an educational seminar in the second or third year of medical school, and a public-private partnership between the Bureau of Health Professions and the Association of American Medical Colleges to create a national database about the shape of the primary care and specialty workforces, accessible through the Internet for educators, students, and policymakers. The authors conclude that appropriate career counseling through these efficient methods could avoid future abrupt swings in specialty choices of medical school graduates and may facilitate a more predictable physician workforce supply. PMID:11299142

  3. Educating primary care clinicians about health disparities

    PubMed Central

    Cardarelli, Roberto; Chiapa, Ana L

    2007-01-01

    Racial and ethnic health disparities inarguably exist in the United States. It is important to educate primary care clinicians regarding this topic because they have the ability to have an impact in the reduction of health disparities. This article presents the evidence that disparities exist, how clinicians contribute to these disparities, and what primary care clinicians can do to reduce disparities in their practice. Clinicians are able to impact health disparities by receiving and providing cross-cultural education, communicating effectively with patients, and practicing evidence-based medicine. The changes suggested herein will have an impact on the current state of health of our nation. PMID:17371577

  4. What is quality primary dental care?

    PubMed

    Campbell, S; Tickle, M

    2013-08-01

    In the first paper of a series exploring quality in primary dental care a definition for quality in dentistry is sought. There is a little agreement in academic literature as to what quality really means in primary dental care and without a true understanding it is difficult to measure and improve quality in a systematic way. 'Quality' of healthcare in dentistry will mean different things to practitioners, policy makers and patients but a framework could be modelled on other definitions within different healthcare sectors, with focus on access, equity and overall healthcare experience.

  5. [Thyroid dysfunction in primary care medicine].

    PubMed

    Wuerzner, Kaisa; Pasche, Olivier; Rodondi, Nicolas; Portmann, Luc

    2010-12-01

    Thyroid function tests include the measuring of the thyroid stimulating hormone (TSH) and free thyroxine (T4) in the case of abnormal TSH. These tests are frequently performed in primary care medicine since many clinical situations can be suggestive of dysthyroidism, as for example fatigue, depressive states or cardiac arthmia. In the case of subclinical thyroid dysfunction, the indications for treatment are controversial there being a lack of significant randomised studies. For primary care physicians faced with abnormal thyroid function tests we propose a diagnostic approach, clinical recommendations, and indications for referral to the specialist. PMID:21207724

  6. [The scientific entertainer in primary health care].

    PubMed

    Ortega-Calvo, Manuel; Santos, José Manuel; Lapetra, José

    2012-09-01

    The scientific method is capable of being applied in primary care. In this article we defend the role of the "scientific entertainer "as strategic and necessary in achieving this goal. The task has to include playful and light-hearted content. We explore some words in English that may help us to understand the concept of "scientific entertainer" from a semantic point of view (showman, master of ceremonies, entrepreneur, go-between) also in Spanish language (counsellor, mediator, methodologist) and finally in Latin and Greek (tripalium, negotium, chronos, kairos). We define the clinical, manager or research health-worker who is skilled in primary care as a "primarylogist". PMID:22018794

  7. [The scientific entertainer in primary health care].

    PubMed

    Ortega-Calvo, Manuel; Santos, José Manuel; Lapetra, José

    2012-09-01

    The scientific method is capable of being applied in primary care. In this article we defend the role of the "scientific entertainer "as strategic and necessary in achieving this goal. The task has to include playful and light-hearted content. We explore some words in English that may help us to understand the concept of "scientific entertainer" from a semantic point of view (showman, master of ceremonies, entrepreneur, go-between) also in Spanish language (counsellor, mediator, methodologist) and finally in Latin and Greek (tripalium, negotium, chronos, kairos). We define the clinical, manager or research health-worker who is skilled in primary care as a "primarylogist".

  8. [Psychosomatic primary care for urinary incontinence].

    PubMed

    Hohenfellner, U

    2015-01-01

    Urinary incontinence is a significant impairment of the quality of life. Many patients are treated insufficiently or even suffer from complications of incontinence surgery. Psychosomatic primary care serves to improve the diagnostic work-up and helps to select the appropriate therapeutic option. It also optimizes the treatment outcome by supplementing the somatically oriented urological therapy with the psychosomatically aligned extended medical dialogue and body-oriented methods. Psychosomatic primary care is based on the biopsychosocial model and uses theoretical knowledge and practical techniques that can be learnt under professional guidance. PMID:25488343

  9. General and specialized media routinely employed for primary isolation of bacterial pathogens of fishes

    USGS Publications Warehouse

    Starliper, C.E.

    2008-01-01

    There are a number of significant diseases among cultured and free-ranging freshwater fishes that have a bacterial etiology; these represent a variety of gram-negative and gram-positive genera. Confirmatory diagnosis of these diseases involves primary isolation of the causative bacterium on bacteriologic media. Frequently used "general" bacteriologic media simply provide the essential nutrients for growth. For most of the major pathogens, however, there are differential and/or selective media that facilitate primary recovery. Some specialized media are available as "ready-to-use" from suppliers, while others must be prepared. Differential media employ various types of indicator systems, such as pH indicators, that allow diagnosticians to observe assimilation of selected substrates. An advantage to the use of differential media for primary isolation is that they hasten bacterial characterization by yielding the appropriate positive or negative result for a particular substrate, often leading to a presumptive identification. Selective media also incorporate agent(s) that inhibit the growth of contaminants typically encountered with samples from aquatic environments. Media that incorporate differential and/or selective components are ideally based on characters that are unique to the targeted bacterium, and their use can reduce the time associated with diagnosis and facilitate early intervention in affected fish populations. In this review, the concepts of general and differential/selective bacteriologic media and their use and development for fish pathogens are discussed. The media routinely employed for primary isolation of the significant bacterial pathogens of fishes are presented. ?? Wildlife Disease Association 2008.

  10. Primary care physician use across the breast cancer care continuum

    PubMed Central

    Jiang, Li; Lofters, Aisha; Moineddin, Rahim; Decker, Kathleen; Groome, Patti; Kendell, Cynthia; Krzyzanowska, Monika; Li, Dongdong; McBride, Mary L.; Mittmann, Nicole; Porter, Geoff; Turner, Donna; Urquhart, Robin; Winget, Marcy; Zhang, Yang; Grunfeld, Eva

    2016-01-01

    Abstract Objective To describe primary care physician (PCP) use and continuity of PCP care across the breast cancer care continuum. Design Population-based, retrospective cohort study using provincial cancer registries linked to health administrative databases. Setting British Columbia, Manitoba, and Ontario. Participants All women with incident invasive breast cancer from 2007 to 2012 in Manitoba and Ontario and from 2007 to 2011 in British Columbia. Main outcome measures The number and proportions of visits to PCPs were determined. Continuity of care was measured using the Usual Provider of Care index calculated as the proportion of visits to the most-often-visited PCP in the 6 to 30 months before a breast cancer diagnosis (baseline) and from 1 to 3 years following a breast cancer diagnosis (survivorship). Results More than three-quarters of patients visited their PCPs 2 or more times during the breast cancer diagnostic period, and more than 80% of patients had at least 1 PCP visit during breast cancer adjuvant treatment. Contact with the PCP decreased over time during breast cancer survivorship. Of the 3 phases, women appeared to be most likely to not have PCP contact during adjuvant treatment, with 10.7% (Ontario) to 18.7% (British Columbia) of women having no PCP visits during this phase. However, a sizable minority of women had at least monthly visits during the treatment phase, particularly in Manitoba and Ontario, where approximately a quarter of women saw a PCP at least monthly. We observed higher continuity of care with PCPs in survivorship (compared with baseline) in all provinces. Conclusion Primary care physicians were generally involved throughout the breast cancer care continuum, but the level of involvement varied across care phases and by province. Future interventions will aim to further integrate primary and oncology care. PMID:27737994

  11. Tobacco use disorder treatment in primary care

    PubMed Central

    Kunyk, Diane; Els, Charl; Papadakis, Sophia; Selby, Peter

    2014-01-01

    Abstract Objective To test a team-based, site-specific, multicomponent clinical system pathway designed for enhancing tobacco use disorder treatment by primary care physicians. Design A prospective cohort study. Setting Sixty primary care sites in Alberta. Participants A convenience sample of 198 primary care physicians from the population of 2857. Main outcome measures Data collection occurred between September 2010 and February 2012 on 3 distinct measures. Twenty-four weeks after the intervention, audits of the primary care practices assessed the adoption and sustainability of 10 tobacco clinical system pathway components, a survey measured changes in physicians’ treatment intentions, and patient chart reviews examined changes in physicians’ consistency with the treatment algorithm. Results The completion rate by physicians was 89.4%. An intention-to-treat approach was undertaken for statistical analysis. Intervention uptake was demonstrated by positive changes at 4 weeks in how many of the 10 clinical system measures were performed (mean [SD] = 4.22 [1.60] vs 8.57 [1.46]; P < .001). Physicians demonstrated significant favourable changes in 9 of the 12 measures of treatment intention (P < .05). The 18 282 chart reviews documented significant increases in 6 of the 8 algorithm components. Conclusion Our findings suggest that the provision of a tobacco clinical system pathway that incorporates other members of the health care team and builds on existing office infrastructures will support positive and sustainable changes in tobacco use disorder treatment by physicians in primary care. This study reaffirms the substantive and important role of supporting how treatment is delivered in physicians’ practices. PMID:25022640

  12. Primary health care of the newborn baby.

    PubMed

    Bhakoo, O N; Kumar, R

    1990-01-01

    More than 50% of infant deaths in India occur during the neonatal period. High priority therefore needs to be given to improving the survival of newborns. A large number of neonatal deaths have their origin in the perinatal period and are mainly determined by the health and nutritional status of the mother, the quality of care during pregnancy and delivery, and the immediate care of the newborn at birth. Main causes of neonatal mortality are birth asphyxia, respiratory problems, and infections, especially tetanus. Most such deaths occur among low birthweight babies. Hypothermia, undernutrition, and mismanaged breast feeding may also indirectly contribute to neonatal mortality. Community-based studies have, however, demonstrated that most neonatal mortality can be affordably prevented through primary health care. Efforts are underway to expand the health care infrastructure, but the outreach of maternal and child health care remains unsatisfactory especially in rural areas. PMID:12319228

  13. Characterizing Primary Care Visit Activities at Veterans Health Administration Clinics.

    PubMed

    Gutierrez, Jennifer C; Terwiesch, Christian; Pelak, Mary; Pettit, Amy R; Marcus, Steven C

    2015-01-01

    Medical home models seek to increase efficiency and maximize the use of resources by ensuring that all care team members work at the top of their licenses. We sought to break down primary care office visits into measurable activities to better under stand how primary care providers (PCPs) currently spend visit time and to provide insight into potential opportunities for revision or redistribution of healthcare tasks. We videotaped 27 PCPs during office visits with 121 patients at four Veterans Health Administration medical centers. Based on patterns emerging from the data, we identified a taxonomy of 12 provider activity categories that enabled us to quantify the frequency and duration of activities occurring during routine primary care visits. We conducted descriptive and multivariate analyses to examine associations between visit characteristics and provider and clinic characteristics. We found that PCPs spent the greatest percentage of their visit time discussing existing conditions (20%), discussing new conditions (18%), record keeping (13%), and examining patients (13%). Providers spent the smallest percentage of time on preventive care and coordination of care. Mean visit length was 22.9 minutes (range 7.9-58.0 minutes). Site-level ratings of medical home implementation were not associated with differences in how visit time was spent. These data provide a window into how PCPs are spending face-to-face time with patients. The methodology and taxonomy presented here may prove useful for future quality improvement and research endeavors, particularly those focused on opportunities to increase nonappointment care and to ensure that team members work at the top of their skill level.

  14. Primary care of adults with developmental disabilities

    PubMed Central

    Sullivan, William F.; Berg, Joseph M.; Bradley, Elspeth; Cheetham, Tom; Denton, Richard; Heng, John; Hennen, Brian; Joyce, David; Kelly, Maureen; Korossy, Marika; Lunsky, Yona; McMillan, Shirley

    2011-01-01

    Abstract Objective To update the 2006 Canadian guidelines for primary care of adults with developmental disabilities (DD) and to make practical recommendations based on current knowledge to address the particular health issues of adults with DD. Quality of evidence Knowledgeable health care providers participating in a colloquium and a subsequent working group discussed and agreed on revisions to the 2006 guidelines based on a comprehensive review of publications, feedback gained from users of the guidelines, and personal clinical experiences. Most of the available evidence in this area of care is from expert opinion or published consensus statements (level III). Main message Adults with DD have complex health issues, many of them differing from those of the general population. Good primary care identifies the particular health issues faced by adults with DD to improve their quality of life, to improve their access to health care, and to prevent suffering, morbidity, and premature death. These guidelines synthesize general, physical, behavioural, and mental health issues of adults with DD that primary care providers should be aware of, and they present recommendations for screening and management based on current knowledge that practitioners can apply. Because of interacting biologic, psychoaffective, and social factors that contribute to the health and well-being of adults with DD, these guidelines emphasize involving caregivers, adapting procedures when appropriate, and seeking input from a range of health professionals when available. Ethical care is also emphasized. The guidelines are formulated within an ethical framework that pays attention to issues such as informed consent and the assessment of health benefits in relation to risks of harm. Conclusion Implementation of the guidelines proposed here would improve the health of adults with DD and would minimize disparities in health and health care between adults with DD and those in the general population

  15. Organisation of Prevention in Primary Health Care.

    ERIC Educational Resources Information Center

    Council of Europe, Strasbourg (France).

    This report examines the possiblities of increasing the amount of preventive work being carried out by primary care workers in European communities. Before making practical recommendations about promoting prevention, an analysis is presented of the main present day problems. These center on the environment (not only physical but also social and…

  16. Primary care in the New Hebrides

    PubMed Central

    de Soldenhoff, R.

    1979-01-01

    The New Hebrides is a small Melanesian country in the South-West Pacific whose doctors are almost entirely recruited from France and Great Britain, the two countries which jointly administer the territory. This paper describes briefly the difficulties of providing primary health care for a fairly primitive island society. PMID:316455

  17. Primary Care in Dentistry - An Untapped Potential

    PubMed Central

    Gambhir, Ramandeep Singh

    2015-01-01

    Dentistry is neither an allied health profession nor a paramedical profession. It is the only anatomically focused health care profession that is university-based and for which primary care responsibility is maintained by the profession. Dentists must have a reliable knowledge of basic clinical medicine for safely and effectively treating individuals with chronic and other diseases, which make them biologically and pharmacologically compromised. With changes in the life expectancy of people and lifestyles, as well as rapid advancement in biomedical sciences, dentists should have similar knowledge like a physician in any other fields of medicine. There are number of primary care activities that can be conducted in the dental office like screening of diabetics, managing hypertension etc., The present review was conducted after doing extensive literature search of peer-reviewed journals. The review throws a spotlight on these activities and also suggests some the measures that can be adopted to modify dental education to turn dentists to oral physicians. PMID:25810982

  18. Redesigning primary care: a strategic vision to improve value by organizing around patients' needs.

    PubMed

    Porter, Michael E; Pabo, Erika A; Lee, Thomas H

    2013-03-01

    Primary care in the United States currently struggles to attract new physicians and to garner investments in infrastructure required to meet patients' needs. We believe that the absence of a robust overall strategy for the entire spectrum of primary care is a fundamental cause of these struggles. To address the absence of an overall strategy and vision for primary care, we offer a framework based on value for patients to sustain and improve primary care practice. First, primary care should be organized around subgroups of patients with similar needs. Second, team-based services should be provided to each patient subgroup over its full care cycle. Third, each patient's outcomes and true costs should be measured by subgroup as a routine part of care. Fourth, payment should be modified to bundle reimbursement for each subgroup and reward value improvement. Finally, primary care patient subgroup teams should be integrated with relevant specialty providers. We believe that redesigning primary care using this framework can improve the ability of primary care to play its essential role in the health care system.

  19. Redesigning primary care: a strategic vision to improve value by organizing around patients' needs.

    PubMed

    Porter, Michael E; Pabo, Erika A; Lee, Thomas H

    2013-03-01

    Primary care in the United States currently struggles to attract new physicians and to garner investments in infrastructure required to meet patients' needs. We believe that the absence of a robust overall strategy for the entire spectrum of primary care is a fundamental cause of these struggles. To address the absence of an overall strategy and vision for primary care, we offer a framework based on value for patients to sustain and improve primary care practice. First, primary care should be organized around subgroups of patients with similar needs. Second, team-based services should be provided to each patient subgroup over its full care cycle. Third, each patient's outcomes and true costs should be measured by subgroup as a routine part of care. Fourth, payment should be modified to bundle reimbursement for each subgroup and reward value improvement. Finally, primary care patient subgroup teams should be integrated with relevant specialty providers. We believe that redesigning primary care using this framework can improve the ability of primary care to play its essential role in the health care system. PMID:23459730

  20. [Renewing primary health care in the Americas].

    PubMed

    Macinko, James; Montenegro, Hernán; Nebot Adell, Carme; Etienne, Carissa

    2007-01-01

    At the 2003 meeting of the Directing Council of the Pan American Health Organization (PAHO), the PAHO Member States issued a mandate to strengthen primary health care (Resolution CD44. R6). The mandate led in 2005 to the document "Renewing Primary Health Care in the Americas. A Position Paper of the Pan American Health Organization/WHO [World Health Organization]," and it culminated in the Declaration of Montevideo, an agreement among the governments of the Region of the Americas to renew their commitment to primary health care (PHC). Scientific data have shown that PHC, regarded as the basis of all the health systems in the Region, is a key component of effective health systems and can be adapted to the range of diverse social, cultural, and economic conditions that exist. The new, global health paradigm has given rise to changes in the population's health care needs. Health services and systems must adapt to address these changes. Building on the legacy of the International Conference on Primary Health Care, held in 1978 in Alma-Ata (Kazakhstan, Union of Soviet Socialist Republics), PAHO proposes a group of strategies critical to adopting PHC-based health care systems based on the principles of equity, solidarity, and the right to the highest possible standard of health. The main objective of the strategies is to develop and/or strengthen PHC-based health systems in the entire Region of the Americas. A substantial effort will be required on the part of health professionals, citizens, governments, associations, and agencies. This document explains the strategies that must be employed at the national, subregional, Regional, and global levels.

  1. Opportunity Knocks: HIV Prevention in Primary Care.

    PubMed

    Thrun, Mark W

    2014-06-01

    Expansions in health care coverage, a comprehensive framework for HIV prevention and care, electronic medical records, and novel HIV prevention modalities create a current opportunity to change the trajectory of the HIV epidemic in the United States. HIV is increasingly disproportionately found in populations historically at higher risk, including gay men and other men who have sex with men, transgender women, injection drug users, and persons of color. This underscores the need for providers to identify persons at higher risk for HIV and assure the provision of screening and prevention services. In turn, universal screening for HIV-testing every adolescent and adult at least once in their lifetime-will increasingly be necessary to find the infrequent cases of HIV in lower risk populations. In both these domains, primary care providers will play a unique role in complementing traditional providers of HIV prevention and care services by increasing the proportion of their patients who have been screened for HIV, opening dialogues around sexual health, including asking about sexual orientation and gender identity, and prescribing antivirals as pre- and postexposure prophylaxis for their non-HIV-infected patients. Primary care providers must understand and embrace their importance along the HIV prevention and care continuum. PMID:26789615

  2. Integrating Primary Medical Care With Addiction Treatment

    PubMed Central

    Weisner, Constance; Mertens, Jennifer; Parthasarathy, Sujaya; Moore, Charles; Lu, Yun

    2010-01-01

    Context The prevalence of medical disorders is high among substance abuse patients, yet medical services are seldom provided in coordination with substance abuse treatment. Objective To examine differences in treatment outcomes and costs between integrated and independent models of medical and substance abuse care as well as the effect of integrated care in a subgroup of patients with substance abuse–related medical conditions (SAMCs). Design Randomized controlled trial conducted between April 1997 and December 1998. Setting and Patients Adult men and women (n=592) who were admitted to a large health maintenance organization chemical dependency program in Sacramento, Calif. Interventions Patients were randomly assigned to receive treatment through an integrated model, in which primary health care was included within the addiction treatment program (n=285), or an independent treatment-as-usual model, in which primary care and substance abuse treatment were provided separately (n=307). Both programs were group based and lasted 8 weeks, with 10 months of aftercare available. Main Outcome Measures Abstinence outcomes, treatment utilization, and costs 6 months after randomization. Results Both groups showed improvement on all drug and alcohol measures. Overall, there were no differences in total abstinence rates between the integrated care and independent care groups (68% vs 63%, P=.18). For patients without SAMCs, there were also no differences in abstinence rates (integrated care, 66% vs independent care, 73%; P=.23) and there was a slight but nonsignificant trend of higher costs for the integrated care group ($367.96 vs $324.09, P=.19). However, patients with SAMCs (n=341) were more likely to be abstinent in the integrated care group than the independent care group (69% vs 55%, P=.006; odds ratio [OR], 1.90; 95% confidence interval [CI], 1.22-2.97). This was true for both those with medical (OR, 3.38; 95% CI, 1.68-6.80) and psychiatric (OR, 2.10; 95% CI, 1

  3. Primary care for people with disabilities.

    PubMed

    Thomas, D C

    1999-05-01

    People with disabilities are a unique population. Although there have been great advances in their care, access to reliable and consistent primary health care remains a difficult issue for many of these patients after discharge from medical rehabilitation units. Many of these health care needs are not unique to this patient population, but become compounded or exacerbated in people with disabilities. The effects of physical impairments on these patients' health need to be recognized. Specific attention must be paid to prevent the occurrence of secondary disabilities, which can drastically affect their independence. Ultimately, proper attention to the health care needs of people with disabilities will result in greater independence and improved health among this population.

  4. Primary Care of Women Aging with HIV

    PubMed Central

    Womack, Julie A.; Brandt, Cynthia A.; Justice, Amy C.

    2016-01-01

    Women are living longer with HIV infection, but their life expectancy is shorter than for women in the general population. How best to manage the multiple comorbidities and polypharmacy that are common in HIV infected individuals has not been studied. This paper explores areas where the primary care of women with HIV may differ from that of aging women in the general population. We also discuss aspects of care that may not commonly be considered in those under the age of 65, specifically multimorbidity and polypharmacy. Incorporating a gerontologic approach in the care of these women may optimize outcomes until research provides more definitive answers as to how best to collaborate with women with HIV to provide them with optimal care. PMID:25782848

  5. Primary care access improvement: an empowerment-interaction model.

    PubMed

    Ledlow, G R; Bradshaw, D M; Shockley, C

    2000-05-01

    Improving community primary care access is a difficult and dynamic undertaking. Realizing a need to improve appointment availability, a systematic approach based on measurement, empowerment, and interaction was developed. The model fostered exchange of information and problem solving between interdependent staff sections within a managed care system. Measuring appointments demanded but not available proved to be a credible customer-focused approach to benchmark against set goals. Changing the organizational culture to become more sensitive to changing beneficiary needs was a paramount consideration. Dependent-group t tests were performed to compare the pretreatment and posttreatment effect. The empowerment-interaction model significantly improved the availability of routine and wellness-type appointments. The availability of urgent appointments improved but not significantly; a better prospective model needs to be developed. In aggregate, appointments demanded but not available (empowerment-interaction model) were more than 10% before the treatment and less than 3% with the treatment. PMID:10826388

  6. Links between systems in Accident & Emergency and primary care.

    PubMed

    Harrop, Nick

    2005-01-01

    The hospital emergency department and other elements of rapid access primary care constitute an emergency care network. Integration aims to maximise the network's strengths and overcome its weaknesses. Taking the patient as a starting point, it is possible to envisage an objective data model that can operate at multiple levels within the network to describe its process efficiency and clinical effectiveness. Other means of integration are also identified. These contain significant subjective elements. In particular, the decision support system of NHSDirect has operated successfully to legitimise national and local intervention based on skill-mix, whereas its technical operation has been susceptible to human deviation from prescribed routine. As we scrutinise a system, we discover that it contains people who are doing things. Logical elements in the system turn out to be givers or recipients of deliberate and thoughtful care. Information systems in Accident & Emergency (A&E) and primary care can help accountable planners to measure and control aspects of the network's operation. Clinicians also need their systems to enable, rather than constrain, effective interactions.

  7. Family history in primary care pediatrics.

    PubMed

    Tarini, Beth A; McInerney, Joseph D

    2013-12-01

    The family history has been called the first genetic test; it was a core element of primary care long before the current wave of genetics technologies and services became clinically relevant. Risk assessment based on family history allows providers to personalize and prioritize health messages, shifts the focus of health care from treatment to prevention, and can empower individuals and families to be stewards of their own health. In a world of rising health care costs, the family history is an important tool, with its primary cost being the clinician's time. However, a recent National Institutes of Health conference highlighted the lack of substantive evidence to support the clinical utility of family histories. Annual collection of a comprehensive 3-generation family history has been held up as the gold standard for practice. However, interval family histories targeted to symptoms and family histories tailored to a child's life stage (ie, age-based health) may be important and underappreciated methods of collecting family history that yield clinically actionable data and supplement existing family history information. In this article, we review the various applications, as well as capabilities and limitations, of the family history for primary care providers.

  8. Family History in Primary Care Pediatrics

    PubMed Central

    McInerney, Joseph D.

    2013-01-01

    The family history has been called the first genetic test; it was a core element of primary care long before the current wave of genetics technologies and services became clinically relevant. Risk assessment based on family history allows providers to personalize and prioritize health messages, shifts the focus of health care from treatment to prevention, and can empower individuals and families to be stewards of their own health. In a world of rising health care costs, the family history is an important tool, with its primary cost being the clinician’s time. However, a recent National Institutes of Health conference highlighted the lack of substantive evidence to support the clinical utility of family histories. Annual collection of a comprehensive 3-generation family history has been held up as the gold standard for practice. However, interval family histories targeted to symptoms and family histories tailored to a child’s life stage (ie, age-based health) may be important and underappreciated methods of collecting family history that yield clinically actionable data and supplement existing family history information. In this article, we review the various applications, as well as capabilities and limitations, of the family history for primary care providers. PMID:24298128

  9. The Quality of Clinical Maternal and Neonatal Healthcare – A Strategy for Identifying ‘Routine Care Signal Functions’

    PubMed Central

    Brenner, Stephan; De Allegri, Manuela; Gabrysch, Sabine; Chinkhumba, Jobiba; Sarker, Malabika; Muula, Adamson S.

    2015-01-01

    Background A variety of clinical process indicators exists to measure the quality of care provided by maternal and neonatal health (MNH) programs. To allow comparison across MNH programs in low- and middle-income countries (LMICs), a core set of essential process indicators is needed. Although such a core set is available for emergency obstetric care (EmOC), the ‘EmOC signal functions’, a similar approach is currently missing for MNH routine care evaluation. We describe a strategy for identifying core process indicators for routine care and illustrate their usefulness in a field example. Methods We first developed an indicator selection strategy by combining epidemiological and programmatic aspects relevant to MNH in LMICs. We then identified routine care process indicators meeting our selection criteria by reviewing existing quality of care assessment protocols. We grouped these indicators into three categories based on their main function in addressing risk factors of maternal or neonatal complications. We then tested this indicator set in a study assessing MNH quality of clinical care in 33 health facilities in Malawi. Results Our strategy identified 51 routine care processes: 23 related to initial patient risk assessment, 17 to risk monitoring, 11 to risk prevention. During the clinical performance assessment a total of 82 cases were observed. Birth attendants’ adherence to clinical standards was lowest in relation to risk monitoring processes. In relation to major complications, routine care processes addressing fetal and newborn distress were performed relatively consistently, but there were major gaps in the performance of routine care processes addressing bleeding, infection, and pre-eclampsia risks. Conclusion The identified set of process indicators could identify major gaps in the quality of obstetric and neonatal care provided during the intra- and immediate postpartum period. We hope our suggested indicators for essential routine care processes

  10. Cancer Survivorship for Primary Care Annotated Bibliography

    PubMed Central

    Westfall, Matthew Y.; Overholser, Linda; Zittleman, Linda; Westfall, John M.

    2015-01-01

    Long-term cancer survivorship care is a relatively new and rapidly advancing field of research. Increasing cancer survivorship rates have created a huge population of long-term cancer survivors whose cancer-specific needs challenge healthcare infrastructure and highlight a significant deficit of knowledge and guidelines in transitional care from treatment to normalcy/prolonged survivorship. As the paradigm of cancer care has changed from a fixation on the curative to the maintenance on long-term overall quality of life, so to, has the delineation of responsibility between oncologists and primary care physicians (PCPs). As more patients enjoy long-term survival, PCPs play a more comprehensive role in cancer care following acute treatment. To this end, this annotated bibliography was written to provide PCPs and other readers with an up-to-date and robust base of knowledge on long-term cancer survivorship, including definitions and epidemiological information as well as specific considerations and recommendations on physical, psychosocial, sexual, and comorbidity needs of survivors. Additionally, significant information is included on survivorship care, specifically Survivorship Care Plans (SPCs) and their evolution, utilization by oncologists and PCPs, and current gaps, as well as an introduction to patient navigation programs. Given rapid advancements in cancer research, this bibliography is meant to serve as current baseline reference outlining the state of the science. PMID:26114091

  11. Prediction of Dementia in Primary Care Patients

    PubMed Central

    Jessen, Frank; Wiese, Birgitt; Bickel, Horst; Eiffländer-Gorfer, Sandra; Fuchs, Angela; Kaduszkiewicz, Hanna; Köhler, Mirjam; Luck, Tobias; Mösch, Edelgard; Pentzek, Michael; Riedel-Heller, Steffi G.; Wagner, Michael; Weyerer, Siegfried; Maier, Wolfgang; van den Bussche, Hendrik

    2011-01-01

    Background Current approaches for AD prediction are based on biomarkers, which are however of restricted availability in primary care. AD prediction tools for primary care are therefore needed. We present a prediction score based on information that can be obtained in the primary care setting. Methodology/Principal Findings We performed a longitudinal cohort study in 3.055 non-demented individuals above 75 years recruited via primary care chart registries (Study on Aging, Cognition and Dementia, AgeCoDe). After the baseline investigation we performed three follow-up investigations at 18 months intervals with incident dementia as the primary outcome. The best set of predictors was extracted from the baseline variables in one randomly selected half of the sample. This set included age, subjective memory impairment, performance on delayed verbal recall and verbal fluency, on the Mini-Mental-State-Examination, and on an instrumental activities of daily living scale. These variables were aggregated to a prediction score, which achieved a prediction accuracy of 0.84 for AD. The score was applied to the second half of the sample (test cohort). Here, the prediction accuracy was 0.79. With a cut-off of at least 80% sensitivity in the first cohort, 79.6% sensitivity, 66.4% specificity, 14.7% positive predictive value (PPV) and 97.8% negative predictive value of (NPV) for AD were achieved in the test cohort. At a cut-off for a high risk population (5% of individuals with the highest risk score in the first cohort) the PPV for AD was 39.1% (52% for any dementia) in the test cohort. Conclusions The prediction score has useful prediction accuracy. It can define individuals (1) sensitively for low cost-low risk interventions, or (2) more specific and with increased PPV for measures of prevention with greater costs or risks. As it is independent of technical aids, it may be used within large scale prevention programs. PMID:21364746

  12. The Role of eHealth in Optimizing Preventive Care in the Primary Care Setting

    PubMed Central

    Noble, Natasha; Mansfield, Elise; Waller, Amy; Henskens, Frans; Sanson-Fisher, Rob

    2015-01-01

    Modifiable health risk behaviors such as smoking, overweight and obesity, risky alcohol consumption, physical inactivity, and poor nutrition contribute to a substantial proportion of the world’s morbidity and mortality burden. General practitioners (GPs) play a key role in identifying and managing modifiable health risk behaviors. However, these are often underdetected and undermanaged in the primary care setting. We describe the potential of eHealth to help patients and GPs to overcome some of the barriers to managing health risk behaviors. In particular, we discuss (1) the role of eHealth in facilitating routine collection of patient-reported data on lifestyle risk factors, and (2) the role of eHealth in improving clinical management of identified risk factors through provision of tailored feedback, point-of-care reminders, tailored educational materials, and referral to online self-management programs. Strategies to harness the capacity of the eHealth medium, including the use of dynamic features and tailoring to help end users engage with, understand, and apply information need to be considered and maximized. Finally, the potential challenges in implementing eHealth solutions in the primary care setting are discussed. In conclusion, there is significant potential for innovative eHealth solutions to make a contribution to improving preventive care in the primary care setting. However, attention to issues such as data security and designing eHealth interfaces that maximize engagement from end users will be important to moving this field forward. PMID:26001983

  13. [Palliative care in Primary Care: presentation of a case].

    PubMed

    Álvarez-Cordovés, M M; Mirpuri-Mirpuri, P G; Gonzalez-Losada, J; Chávez-Díaz, B

    2013-10-01

    We present a case of a patient diagnosed with glioblastoma multiforme refractory to treatment. Glioblastoma multiforme is the most common primary brain tumour and unfortunately the most aggressive, with an estimated mortality of about 90% in the first year after diagnosis. In our case the patient had reached a stage of life where quality of life was importsnt, with palliative care being the only recourse. The family is the mainstay in the provision of care of terminally ill patients, and without their active participation it would be difficult to achieve the objectives in patient care. We must also consider the family of the terminally ill in our care aim, as its members will experience a series of changes that will affect multiple areas where we should take action.

  14. The entrepreneurial role in primary care dentistry.

    PubMed

    Willcocks, S

    2012-03-01

    This paper explores the entrepreneurial role of dentists in primary care dentistry. It reviews the changing context of dentistry, not least the reforms being introduced by the health and social care bill. It suggests that this new context will reinforce the need to consider the business side of dental practice, in particular, the importance of quality, creativity and innovation, alongside the importance of meeting the needs of patients. An entrepreneurial approach will be required in order to sustain dental practice in an increasingly competitive environment. PMID:22402534

  15. Contribution of Primary Care to Health Systems and Health

    PubMed Central

    Starfield, Barbara; Shi, Leiyu; Macinko, James

    2005-01-01

    Evidence of the health-promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system. This evidence shows that primary care helps prevent illness and death, regardless of whether the care is characterized by supply of primary care physicians, a relationship with a source of primary care, or the receipt of important features of primary care. The evidence also shows that primary care (in contrast to specialty care) is associated with a more equitable distribution of health in populations, a finding that holds in both cross-national and within-national studies. The means by which primary care improves health have been identified, thus suggesting ways to improve overall health and reduce differences in health across major population subgroups. PMID:16202000

  16. Health system challenges to integration of mental health delivery in primary care in Kenya- perspectives of primary care health workers

    PubMed Central

    2013-01-01

    the detriment of other health issues. Conclusion Generic health system weaknesses in Kenya impact on efforts for horizontal integration of mental health into routine primary care practice, and greatly frustrate health worker efforts. Improvement of medicine supplies, information systems, explicit inclusion of mental health in district level targets, management and supervision to primary care are likely to greatly improve primary care health worker effectiveness, and enable training programmes to be followed by better use in the field of newly acquired skills. A major lever for horizontal integration of mental health into the health system would be the inclusion of mental health in the national health sector reform strategy at community, primary care and district levels rather than just at the higher provincial and national levels, so that supportive supervision from the district level to primary care would become routine practice rather than very scarce activity. Trial registration Trial registration ISRCTN 53515024 PMID:24079756

  17. Parents’ role in adolescent depression care: primary care provider perspectives

    PubMed Central

    Radovic, Ana; Reynolds, Kerry; McCauley, Heather L.; Sucato, Gina S.; Stein, Bradley D.; Miller, Elizabeth

    2015-01-01

    Objective To understand how primary care providers (PCPs) perceive barriers to adolescent depression care to inform strategies to increase treatment engagement. Study design We conducted semi-structured interviews with 15 PCPs recruited from community pediatric offices with access to integrated behavioral health services (i.e., low system-level barriers to care) who participated in a larger study on treating adolescent depression. Interviews addressed PCP perceptions of barriers to adolescents’ uptake of care for depression. Interviews were audio-recorded, transcribed, and coded for key themes. Results Although PCPs mentioned several adolescent barriers to care, they thought parents played a critical role in assisting adolescents in accessing mental health services. Important aspects of the parental role in accessing treatment included transportation, financial support, and social support. PCP’s perceived that parental unwillingness to accept the depression diagnosis, family dysfunction and trauma were common barriers. PCPs contrasted this with examples of good family support they believed would enable adolescents to attend follow-up appointments and have a “life coach” at home to help monitor for side effects and watch for increased suicidality when starting antidepressants. Conclusions In this PCP population, which had enhanced access to mental health specialists, PCPs primarily reported attitudinal barriers to adolescent depression treatment, focusing mainly on perceived parent barriers. The results of these qualitative interviews provide a framework for understanding PCP perceptions of parental barriers to care, identifying that addressing complex parental barriers to care may be important for future interventions. PMID:26143382

  18. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... care case management services. (a) Primary care case management services means case management related services that— (1) Include location, coordination, and monitoring of primary health care services; and (2... 42 Public Health 4 2010-10-01 2010-10-01 false Primary care case management services....

  19. Biofield therapies: energy medicine and primary care.

    PubMed

    Rindfleisch, J Adam

    2010-03-01

    Energy medicine modalities, also known as biofield therapies, are perhaps the most mysterious and controversial complementary alternative medicine therapies. Although many of these approaches have existed for millennia, scientific investigation of these techniques is in its early stages; much remains to be learned about mechanisms of action and efficacy. These techniques are increasingly used in clinical and hospital settings and can be incorporated into an integrative primary care practice. This article describes several energy medicine and biofield therapies and outlines key elements they hold in common. Several specific approaches are described. Research findings related to the efficacy of energy medicine are summarized, and proposed mechanisms of action and safety issues are discussed. Guidelines are offered for primary care providers wishing to advise patients about energy medicine or to integrate it into their practices, and Internet and other resources for obtaining additional information are provided.

  20. The productivity of primary care research networks.

    PubMed Central

    Griffiths, F; Wild, A; Harvey, J; Fenton, E

    2000-01-01

    Primary care research networks are being publicly funded in the United Kingdom to promote a culture of research and development in primary care. This paper discusses the organisational form of these networks and how their productivity can be evaluated, drawing on evidence from management science. An evaluation of a research network has to take account of the complexity of the organisation, the influence of its local context, and its stage of development. Output measures, such as number of research papers, and process measures, such as number of research meetings, may contribute to an evaluation. However, as networking relies on the development of informal, trust-based relationships, the quality of interactions within a network is of paramount importance for its success. Networks can audit and reflect on their success in promoting such relationships and a more formal qualitative evaluation by an independent observer can document their success to those responsible for funding. PMID:11141879

  1. The productivity of primary care research networks.

    PubMed

    Griffiths, F; Wild, A; Harvey, J; Fenton, E

    2000-11-01

    Primary care research networks are being publicly funded in the United Kingdom to promote a culture of research and development in primary care. This paper discusses the organisational form of these networks and how their productivity can be evaluated, drawing on evidence from management science. An evaluation of a research network has to take account of the complexity of the organisation, the influence of its local context, and its stage of development. Output measures, such as number of research papers, and process measures, such as number of research meetings, may contribute to an evaluation. However, as networking relies on the development of informal, trust-based relationships, the quality of interactions within a network is of paramount importance for its success. Networks can audit and reflect on their success in promoting such relationships and a more formal qualitative evaluation by an independent observer can document their success to those responsible for funding. PMID:11141879

  2. Pharmacotherapy for Insomnia in Primary Care

    PubMed Central

    Smith, Emily; Narang, Puneet; Enja, Manasa; Lippmann, Steven

    2016-01-01

    Pharmacotherapy for insomnia in primary care settings can be challenging. Frequently, there are multiple coexisting medical and psychiatric conditions, drug interactions, concern regarding use of habit-forming sleep aids, and paucity of time in office visits to discuss management of sleep difficulties. This article reports the results of a literature search related to pharmacotherapy for insomnia and presents 4 clinical vignettes with corresponding treatment options. PMID:27486547

  3. Pharmacotherapy for Insomnia in Primary Care.

    PubMed

    Smith, Emily; Narang, Puneet; Enja, Manasa; Lippmann, Steven

    2016-01-01

    Pharmacotherapy for insomnia in primary care settings can be challenging. Frequently, there are multiple coexisting medical and psychiatric conditions, drug interactions, concern regarding use of habit-forming sleep aids, and paucity of time in office visits to discuss management of sleep difficulties. This article reports the results of a literature search related to pharmacotherapy for insomnia and presents 4 clinical vignettes with corresponding treatment options. PMID:27486547

  4. [Experience in treating mucoceles in Primary Care].

    PubMed

    Sabando Carranza, J A; Cortés Martinez, M; Calvo Carrasco, D

    2016-03-01

    Several cases of mucocele have been treated in our Primary Health Care centre. These are benign lesions, relatively frequent (2.5/1000), which is caused by a retention of mucous from the minor salivary glands into the oral cavity, mainly at the level of the lower lip. The experience in their treatment in this centre is presented, along with a review of the literature to see if our treatment was correct. PMID:26163872

  5. Acquisition and maintenance of health-care routines as a function of feedback density.

    PubMed Central

    Alavosius, M P; Sulzer-Azaroff, B

    1990-01-01

    Two schedules of feedback were examined to determine their relative effects on the acquisition and maintenance of three health-care routines: feeding, positioning, and transferring physically disabled patients. Four direct service providers' performances in the natural environment were measured weekly. Concurrent schedules and multiple baselines across subjects and response classes were used to evaluate the effects of written instructions combined with either continuous, intermittent, or nofeedback schedules. Results showed that instructions alone led to slight and usually brief changes. Marked improvements were noted after feedback was introduced, with the continuous schedule producing more rapid acquisition. Follow-up measures indicated performance maintenance for both schedules. Subjects rated the feedback programs favorably and recommended provision of this service to co-workers. Cost estimates indicated that, although considerable time was spent developing the observational system, the feedback procedure was relatively inexpensive, easy to use, and did not interfere with patient care. PMID:2373652

  6. Shoulder pain in primary care: frozen shoulder.

    PubMed

    Cadogan, Angela; Mohammed, Khalid D

    2016-03-01

    BACKGROUND AND CONTEXT Frozen shoulder is a painful condition that follows a protracted clinical course. We aim to review the management of patients with a diagnosis of frozen shoulder who are referred for specialist orthopaedic evaluation against existing guidelines in primary care. ASSESSMENT OF PROBLEM Referrals and clinical records were reviewed for all patients referred for orthopaedic specialist assessment who received a specialist diagnosis of frozen shoulder. Diagnostic, investigation and management practices from a regional primary health care setting in New Zealand were compared with guideline-recommended management. RESULTS Eighty patients with frozen shoulder were referred for orthopaedic evaluation in the 13 month study period, mostly from general practice. Fifteen patients (19%) were identified as having a frozen shoulder in their medical referral. Most (99%) had received previous imaging. Seven patients (12%) had received guideline recommended treatment. STRATEGIES FOR IMPROVEMENT Education of all clinicians involved in patient management is important to ensure an understanding of the long natural history of frozen shoulder and provide reassurance that outcomes are generally excellent. HealthPathways now include more information regarding diagnosis, imaging and evidence-based management for frozen shoulder. LESSONS Frozen shoulder may be under-diagnosed among patients referred for orthopaedic review. Ultrasound imaging is commonly used and may identify occult and unrelated pathology in this age-group. When managed according to clinical guidelines, patients report significant clinical and functional improvement with most reporting 80% function compared with normal after 1 year. KEYWORDS Adhesive capsulitis; bursitis; injections; practice guideline; primary health care; ultrasound.

  7. Two models of primary health care training.

    PubMed

    Hill, P; Samisoni, J

    1993-01-01

    In 1991, the Fiji School of Medicine restructured the training of its medical students, dividing the 7-year course into two phases. Students now undertake a 3-year community-oriented primary care practitioners course, after which they may elect to continue practice in a primary health care role, or to undertake further hospital-based training to complete their medical degree. The course responds to the health needs of the South Pacific, and the local patterns of morbidity and mortality, rather than measuring itself against the curricular demands of its more developed neighbours, Australia and New Zealand. At the same time, the Tropical Health Program of the University of Queensland Medical School responded to demands from the Aboriginal and Torres Strait Islander community to develop primary health care training at degree level. This was intended to complement other strategies undertaken by the Aboriginal and Torres Strait Islander Studies Unit such as the recruitment and support of indigenous students through mainstream health professional education. There was a need to address health priorities that are very different to those of the Australian population as a whole, as well as the sociopolitical and cultural context as it affects both students themselves and health issues in their communities. Both institutions have chosen problem-based teaching/learning as appropriate to their courses, and content is also similar, though with emphases that reflect the differing contexts. The two courses are examples of innovative responses by centres with university medical faculties to specific issues in health education. PMID:8433664

  8. Preventing violence through primary care intervention.

    PubMed

    Roberts, C; Quillian, J

    1992-08-01

    Homicide was the United States' second leading cause of death among people aged 15 to 24 in 1988; non-fatal assaults occur 100 times more frequently. Yet as a society, we have ignored the problem. Risk factors for violent injuries comprise sociological, developmental/psychological and neurophysiological elements. Providers of primary care for children, young adults and their families can help parents develop healthy parenting techniques in child-rearing, help the grade-school-aged child develop non-violent conflict-resolution skills, and help young people learn to avoid violence and potentially violent activities and situations. Health care providers are able to reduce the incidence of violent injuries by addressing the issue of violence in periodic examination visits with both parents and children. Familiarity with risk indicators enables the health care provider to intervene early when needed. An anticipatory guidance outline and a violence-induced injury-visit form are included. PMID:1294082

  9. The adoption of the Reference Framework for diabetes care among primary care physicians in primary care settings: A cross-sectional study.

    PubMed

    Wong, Martin C S; Wang, Harry H X; Kwan, Mandy W M; Chan, Wai Man; Fan, Carmen K M; Liang, Miaoyin; Li, Shannon Ts; Fung, Franklin D H; Yeung, Ming Sze; Chan, David K L; Griffiths, Sian M

    2016-08-01

    The prevalence of diabetes mellitus has been increasing both globally and locally. Primary care physicians (PCPs) are in a privileged position to provide first contact and continuing care for diabetic patients. A territory-wide Reference Framework for Diabetes Care for Adults has been released by the Hong Kong Primary Care Office in 2010, with the aim to further enhance evidence-based and high quality care for diabetes in the primary care setting through wide adoption of the Reference Framework.A valid questionnaire survey was conducted among PCPs to evaluate the levels of, and the factors associated with, their adoption of the Reference Framework.A total of 414 completed surveys were received with the response rate of 13.0%. The average adoption score was 3.29 (SD 0.51) out of 4. Approximately 70% of PCPs highly adopted the Reference Framework in their routine practice. Binary logistic regression analysis showed that the PCPs perceptions on the inclusion of sufficient local information (adjusted odds ratio [aOR] = 4.748, 95%CI 1.597-14.115, P = 0.005) and reduction of professional autonomy of PCPs (aOR = 1.859, 95%CI 1.013-3.411, P = 0.045) were more likely to influence their adoption level of the Reference Framework for diabetes care in daily practices.The overall level of guideline adoption was found to be relatively high among PCPs for adult diabetes in primary care settings. The adoption barriers identified in this study should be addressed in the continuous updating of the Reference Framework. Strategies need to be considered to enhance the guideline adoption and implementation capacity.

  10. Primary Care of the Prostate Cancer Survivor.

    PubMed

    Noonan, Erika M; Farrell, Timothy W

    2016-05-01

    This summary of the American Cancer Society Prostate Cancer Survivorship Care Guidelines targets primary care physicians who coordinate care of prostate cancer survivors with subspecialists. Prostate cancer survivors should undergo prostate-specific antigen screening every six to 12 months and digital rectal examination annually. Surveillance of patients who choose watchful waiting for their prostate cancer should be conducted by a subspecialist. Any hematuria or rectal bleeding must be thoroughly evaluated. Prostate cancer survivors should be screened regularly for urinary incontinence and sexual dysfunction. Patients with predominant urge incontinence symptoms, which can occur after surgical and radiation treatments, may benefit from an anticholinergic agent. If there is difficulty with bladder emptying, a trial of an alpha blocker may be considered. A phosphodiesterase type 5 inhibitor can effectively treat sexual dysfunction following treatment for prostate cancer. Osteoporosis screening should occur before initiation of androgen deprivation therapy, and patients treated with androgen deprivation therapy should be monitored for anemia, metabolic syndrome, and vasomotor symptoms. Healthy lifestyle choices should be encouraged, including weight management, regular physical activity, proper nutrition, and smoking cessation. Primary care physicians should be vigilant for psychosocial distress, including depression, among prostate cancer survivors, as well as the potential impact of this distress on patients' family members and partners. PMID:27175954

  11. Providing high-quality care in primary care settings

    PubMed Central

    Beaulieu, Marie-Dominique; Geneau, Robert; Grande, Claudio Del; Denis, Jean-Louis; Hudon, Éveline; Haggerty, Jeannie L.; Bonin, Lucie; Duplain, Réjean; Goudreau, Johanne; Hogg, William

    2014-01-01

    Abstract Objective To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Design Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Setting Three regions of Quebec. Participants Health care professionals and staff of 5 PC practices. Methods Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. Main findings The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Conclusion Irrespective of their models, PC practices’ pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care. PMID:24829023

  12. Physiological and Behavioral Stress and Anxiety in Children with Autism Spectrum Disorders during Routine Oral Care

    PubMed Central

    Lane, Christianne J.; Williams, Marian E.; Dawson, Michael E.; Polido, José C.; Cermak, Sharon A.

    2014-01-01

    Background. Children with autism spectrum disorders (ASD) commonly exhibit uncooperative behaviors which impede oral care. Previous studies have utilized dentist-report measures of uncooperative behaviors in children with ASD but none have utilized an objective measure of children's behavior or a physiological measure of distress. This study investigated behavioral and physiological distress in children with ASD during routine oral care and examined factors associated with this distress. Methods. Participants were 44 children (n = 22 typical, n = 22 ASD) aged 6–12 receiving routine dental cleanings. Behavioral and physiological measures of stress and anxiety were collected during dental cleanings. Results. Children with ASD exhibited greater distress, compared to the typical group, on dentist-report and researcher-coded measures of overt distress behaviors and on physiological measures. Correlations between physiological and behavioral measures of distress were found in the ASD but not in the typical group. Behavioral distress was correlated with age in the typical group and with expressive communication ability and sensory processing difficulties in the ASD group; physiological distress was correlated with parent-report of anxiety in the typical group and sensory processing difficulties in the ASD group. Conclusions. Novel strategies may be required to decrease behavioral and physiological distress in children with ASD in the dental clinic. PMID:25114916

  13. Primary Care Physicians Practicing Preventive Medicine in the Outpatient Setting

    PubMed Central

    Snipelisky, David; Carter, Kimberly; Sundsted, Karna; Burton, M. Caroline

    2016-01-01

    Background: Preventive care is an important part of primary care medicine, yet much variation in its practice exists. The aim of this study is to assess physicians’ perspectives of practicing preventive medicine and evaluate which topics are deemed most important. Methods: All primary care medicine providers at two separate academic medical centers (Mayo Clinic, MN and Mayo Clinic, FL) were surveyed via an E-mail questionnaire assessing physicians’ perception of the role of preventive medicine during both acute/routine and yearly visits, physicians’ perception of patients’ response to preventive medicine topics, and which preventive medicine topics are commonly practiced. Results: Of 445 providers meeting inclusion criteria, a total of 183 (41.1%) responded. Providers were more likely to engage patients in preventive medicine during yearly visits more so than acute visits (3.82 vs. 4.72, range 1–5 Likert Scale), yet providers were very likely to partake in such practices during both visits. Providers perceived that patients received the practice of preventive medicine very well (4.13 on 1–5 Likert Scale). No significant difference between provider practice and patient perception was noted between the two sites, although there was some variation based on clinical experience of the provider. Providers were found to most commonly practice topics recommended by the United States Preventive Services Task Force. Conclusions: Our study found a high predisposition to practicing preventive medicine. Providers seem to practice according to published evidence-based medicine recommendations. PMID:26941906

  14. Extinction of care-induced vocalizations by a desensitization routine on a palliative care unit.

    PubMed

    Adams, Jennifer; Cheng, P; Deonarain, L; Frank, C; Mayers, A; Smith, Beverley Jean; Yuen, Harold

    2012-06-01

    Vocalizations during care occur frequently in patients with dementia, and are not uncommon in the palliative setting. Underlying trigger factors may include pain during movement, fear of being turned, startle reflex, attempts at verbal communication, environmental factors such as cold water, and other possible etiologies. A case of a 92 year old female who screamed and called out during bathing is presented. This patient with comorbid dementia and brain lesions did not respond to pre-event pain medication, and became somnolent due to opioid administration for presumed incident pain. A non-pharmacological approach, with a patient-centered focus rather than task orientation, succeeded in extinguishing the vocalizations after a period of six weeks. PMID:21908456

  15. Primary care role in expanded newborn screening

    PubMed Central

    Hayeems, Robin Z.; Miller, Fiona A.; Carroll, June C.; Little, Julian; Allanson, Judith; Bytautas, Jessica P.; Chakraborty, Pranesh; Wilson, Brenda J.

    2013-01-01

    Abstract Objective To examine the role of primary care providers in informing and supporting families who receive positive screening results. Design Cross-sectional survey. Setting Ontario. Participants Family physicians, pediatricians, and midwives involved in newborn care. Main outcome measures Beliefs, practices, and barriers related to providing information to families who receive positive screening results for their newborns. Results A total of 819 providers participated (adjusted response rate of 60.9%). Of the respondents, 67.4% to 81.0% agreed that it was their responsibility to provide care to families of newborns who received positive screening results, and 64.2% to 84.8% agreed they should provide brochures or engage in general discussions about the identified conditions. Of the pediatricians, 67.3% endorsed having detailed discussions with families, but only 24.1% of family physicians and 27.6% of midwives endorsed this practice. All provider groups reported less involvement in information provision than they believed they should have. This discrepancy was most evident for family physicians: most stated that they should provide brochures (64.2%) or engage in general discussions (73.5%), but only a minority did so (15.3% and 27.7%, respectively). Family physicians reported insufficient time (42.2%), compensation (52.2%), and training (72.3%) to play this role, and only a minority agreed they were up to date (18.5%) or confident (16.5%) regarding newborn screening. Conclusion Providers of primary newborn care see an information-provision role for themselves in caring for families who receive positive newborn screening results. Efforts to further define the scope of this role combined with efforts to mitigate existing barriers are warranted. PMID:23946032

  16. Health Checks in Primary Care for Adults with Intellectual Disabilities: How Extensive Should They Be?

    ERIC Educational Resources Information Center

    Chauhan, U.; Kontopantelis, E.; Campbell, S.; Jarrett, H.; Lester, H.

    2010-01-01

    Background: Routine health checks have gained prominence as a way of detecting unmet need in primary care for adults with intellectual disabilities (ID) and general practitioners are being incentivised in the UK to carry out health checks for many conditions through an incentivisation scheme known as the Quality and Outcomes Framework (QOF).…

  17. Nonsuicidal Self-Injury among Adolescents: A Training Priority for Primary Care Providers

    ERIC Educational Resources Information Center

    Taliaferro, Lindsay A.; Muehlenkamp, Jennifer J.; Hetler, Joel; Edwall, Glenace; Wright, Catherine; Edwards, Anne; Borowsky, Iris W.

    2013-01-01

    Primary care providers were surveyed to determine how prepared they feel to address nonsuicidal self-injury (NSSI) among adolescents, their interest in training on NSSI, and factors associated with routinely asking about NSSI when providing health supervision. Participants included family medicine physicians ("n" = 260), pediatricians…

  18. Organizing care across the continuum: primary care, specialty services, acute and long-term care.

    PubMed

    Oelke, Nelly D; Cunning, Leslie; Andrews, Kaye; Martin, Dorothy; MacKay, Anne; Kuschminder, Katie; Congdon, Val

    2009-01-01

    Primary care networks (PCNs) facilitate integration of healthcare across the continuum. The Calgary Rural PCN implemented a community-based model where physicians and Alberta Health Services work together to deliver primary care addressing local population needs. This model is highly valued by physicians, decision-makers and providers, with early impacts on outcomes.

  19. Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties

    PubMed Central

    Hamad, A. K.; Whittall, C.; Graham, N. M.; Banerjee, R. D.; Kuiper, J. H.

    2016-01-01

    Objectives Wound complications are reported in up to 10% hip and knee arthroplasties and there is a proven association between wound complications and deep prosthetic infections. In this randomised controlled trial (RCT) we explore the potential benefits of a portable, single use, incisional negative pressure wound therapy dressing (iNPWTd) on wound exudate, length of stay (LOS), wound complications, dressing changes and cost-effectiveness following total hip and knee arthroplasties. Methods A total of 220 patients undergoing elective primary total hip and knee arthroplasties were recruited into in a non-blinded RCT. For the final analysis there were 102 patients in the study group and 107 in the control group. Results An improvement was seen in the study (iNPWTd) group compared to control in all areas. Peak post-surgical wound exudate was significantly reduced (p = 0.007). Overall LOS reduction (0.9 days, 95% confidence interval (CI) -0.2 to 2.5) was not significant (p = 0.07) but there was a significant reduction in patients with extreme values of LOS in the iNPWTd group (Moses test, p = 0.003). There was a significantly reduced number of dressing changes (mean difference 1.7, 95% CI 0.8 to 2.5, p = 0.002), and a trend to a significant four-fold reduction in reported post-operative surgical wound complications (8.4% control; 2.0% iNPWTd, p = 0.06). Conclusions Based on the results of this RCT incisional negative pressure wound therapy dressings have a beneficial role in patients undergoing primary hip and knee arthroplasty to achieve predictable length of stay, especially to eliminate excessive hospital stay, and minimise wound complications. Cite this article: S. L. Karlakki, A. K. Hamad, C. Whittall, N. M. Graham, R. D. Banerjee, J. H. Kuiper. Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties: A randomised controlled trial. Bone Joint Res 2016;5:328–337. DOI: 10.1302/2046-3758.58.BJR-2016-0022.R1 PMID

  20. Integrating family-centered developmental assessment and intervention into routine care in the neonatal intensive care unit.

    PubMed

    McGrath, J M; Conliffe-Torres, S

    1996-06-01

    Incorporating developmental intervention into routine practices requires time available during caregiving for continued infant assessment and intervention and requires time after and between caregiving for relief of infant distress. In an era of health-care reform, reorganization, and restructuring, this added caregiver time appears unavailable. However, nurses need to work together in meeting the developmental challenges of the NICU. Further research needs to be done to validate which interventions are appropriate for which babies and with what medical procedures. In addition, collaboration and sharing of responsibilities and resources with all care providers needs to be investigated. Moreover, research needs to be done that acknowledges that the environment of the NICU is also a world in which many adults work and live a large portion of their daily life. This environment must be supportive of their social needs as well as the needs of the high-risk infant. There are many pieces to the puzzle of providing developmentally supportive caregiving in the NICU. The number of different issues increases the complexity of changing the standard of care: Infant, family, environment. Each has its own challenges. However, with sensitivity, a collaborative approach, and a sincere effort to change, neonatal health-care professionals can integrate developmental practices into the NICU. PMID:8637813

  1. Primary health care in South Africa.

    PubMed

    Buch, E

    1989-01-01

    Even though most countries have committed to primary health care (PHC), South Africa, a middle-income country, has an inadequate PHC system. The poor system has roots in the colonial period and apartheid reinforces this system. Race, class, and place of residence determine the type of health care individuals receive. South Africa falls far short of all 5 principles of PHC. Just 12% of the health budget goes to 40% of the population who live in the homelands which shows the inequitable distribution of health care resources and inadequate quality health care for all. Similarly, South Africa has not altered its communication and education techniques to improve preventive and promotive health services. It has not implemented any successful national campaigns such as a campaign against diarrhea deaths. South Africa does not make good use of available appropriate technology such as breast feeding, oral rehydration, refrigeration, and the ventilated improved pit latrine which lead to health for all. People in South Africa discuss community participation but it is not likely to occur without general political democracy. Some people have made local attempts at community participation but they tend to use inflexible means and request either cash or contributions in kind from people who have little. The elite in South Africa has not recognized the need to correct socioeconomic inequalities. The Population Development Plan Programme among white farmer-owners has showed some support for a multisectoral approach to improve health care, however. For example, it acknowledges that non-health-care interventions such as better salaries, literacy, and living conditions, lead to better health. The Department of National Health has discussed improved coordination of the budget to allow priority determination of national PHD and manpower plans. Nongovernmental organizations are beginning to use the PHC approach instead of the charitable approach.

  2. A Primary Care Approach to Myelodysplastic Syndromes

    PubMed Central

    Samiev, Djamshed; Bhatt, Vijaya R.; Armitage, Joel D.; Maness, Lori J

    2014-01-01

    Myelodysplastic syndromes (MDS) are probably the most common hematologic malignancies in adults over the age of 60 and are a major source of morbidity and mortality among older age groups. Diagnosis and management of this chronic blood cancer has evolved significantly in recent years and there are Food and Drug Administration-approved therapies that can extend patients' life expectancy and improve quality of life. Primary care physicians (PCPs) are often involved in the process of diagnosis and follow-up of MDS patients, especially those in low-risk groups. They can therefore play an important role in improving patient care and quality of life by ensuring early referral and participating in supportive management. There is also a shortage of oncologists which increases the importance of the role of PCPs in management of MDS patients. In the face of limited resources, PCPs can improve access and quality of care in MDS patients. This article provides an overview of the common manifestations, diagnostic approaches, and therapeutic modalities of MDS for PCPs, with a focus on when to suspect MDS, when a referral is appropriate, and how to provide appropriate supportive care for patients diagnosed with MDS. PMID:24921029

  3. Medicaid Managed Care Model of Primary Care and Health Care Management for Individuals with Developmental Disabilities

    ERIC Educational Resources Information Center

    Kastner, Theodore A.; Walsh, Kevin K.

    2006-01-01

    Lack of sufficient accessible community-based health care services for individuals with developmental disabilities has led to disparities in health outcomes and an overreliance on expensive models of care delivered in hospitals and other safety net or state-subsidized providers. A functioning community-based primary health care model, with an…

  4. Managed care can be better care for all citizens: a primary care perspective.

    PubMed

    Bartholow, T

    1997-01-01

    The CPN seeks to enhance the care of patients by judicious expenditure of health care dollars, currently for the Unit "Community" Network, but ultimately also for other insurers who would enter risk-sharing relationships with the CPN. Improvements in health care delivery will be made in enhanced access to primary care, including telephone access to nurse triage; in collaboration and communication between the selected consultant and the referring primary care giver, including an electronic network allowing for selected information sharing; and in renewing medicine's collective commitment to care provided as close to home as possible, or in the home if this is the highest quality. The care of the uninsured remains a challenge and a normal obligation from which the CPN does not shrink. The economic realities of primary care delivery must be improved, with additional resources allocated being substantially rededicated to patient care. The patient's control of the selection of the site of health care and the absence of incentives to their primary care provider for a referral pattern different than the patient's choice will remain important to the CPN. The CPN hopes to provide the diplomacy between third party payers to enhance collaboration and minimize competition in the delivery of care in communities.

  5. Primary care as intersecting social worlds.

    PubMed

    Tovey, P; Adams, J

    2001-03-01

    An enhanced role for primary health care (PHC) is currently a matter of political priority in the UK. This higher profile is drawing attention to a range of unresolved challenges and issues, relating to both the structure and content of provision, which currently permeate the system. Running in parallel with this is a recognition that: to date, PHC has been under-researched; that, as a result, our understanding of it is frequently poor; and that, as a consequence, fresh perspectives are needed in order to effectively research this uncertain, evolving and increasingly important healthcare sector. In this paper we argue that social worlds theory (SWT) provides, albeit in a suitably modified form, an ideal conceptual framework for the analysis of contemporary primary care. SWT is an approach which assumes complexity and constant evolution, and its core concepts are directed towards unravelling the consequences of encounters between different interest groups--something which is of particular utility at this time given the increasing attention to user participation, and an ongoing questioning of established patterns of professional authority. It is an approach which has rarely been employed empirically, even beyond medicine. In order to illustrate the wide relevance of the approach, we discuss how it can facilitate research at all levels of PHC: i.e., in relation to aspects of medical practice (the case of medically unexplained symptoms); shifts in service organisation (changing professional roles and the introduction of policy reforms); and issues which straddle both organisation and content (the increasing use of complementary medicine in primary care). In each case the approach is able to embrace the complexity of situations characterised by the intersection of professional and lay social worlds and is able to provide the conceptual tools through which resultant processes can be tracked and investigated. PMID:11218174

  6. Primary care as intersecting social worlds.

    PubMed

    Tovey, P; Adams, J

    2001-03-01

    An enhanced role for primary health care (PHC) is currently a matter of political priority in the UK. This higher profile is drawing attention to a range of unresolved challenges and issues, relating to both the structure and content of provision, which currently permeate the system. Running in parallel with this is a recognition that: to date, PHC has been under-researched; that, as a result, our understanding of it is frequently poor; and that, as a consequence, fresh perspectives are needed in order to effectively research this uncertain, evolving and increasingly important healthcare sector. In this paper we argue that social worlds theory (SWT) provides, albeit in a suitably modified form, an ideal conceptual framework for the analysis of contemporary primary care. SWT is an approach which assumes complexity and constant evolution, and its core concepts are directed towards unravelling the consequences of encounters between different interest groups--something which is of particular utility at this time given the increasing attention to user participation, and an ongoing questioning of established patterns of professional authority. It is an approach which has rarely been employed empirically, even beyond medicine. In order to illustrate the wide relevance of the approach, we discuss how it can facilitate research at all levels of PHC: i.e., in relation to aspects of medical practice (the case of medically unexplained symptoms); shifts in service organisation (changing professional roles and the introduction of policy reforms); and issues which straddle both organisation and content (the increasing use of complementary medicine in primary care). In each case the approach is able to embrace the complexity of situations characterised by the intersection of professional and lay social worlds and is able to provide the conceptual tools through which resultant processes can be tracked and investigated.

  7. Training the internist for primary care: a view from Nevada.

    PubMed

    Kurtz, K J

    1982-01-01

    The recent establishment of primary care residencies at the University of Nevada School of Medicine has raised important questions about local priorities in the training of physicians to provide primary care for adults. Because the amount of money available for health care training is decreasing, these questions also have national importance. Primary care internal medicine, not synonymous with general internal medicine, offers distinct advantages to patients over family practice adult care and primary care offered by internist subspecialists. The University of Nevada has a singular opportunity to organize a strong primary care internal medicine residency, but national problems of internal medicine emphasis exist. Nationwide changes in internal medicine residency programs (ongoing) and American Board of Internal Medicine nationalization of the fledgling primary care internal medicine fellowship movement are suggested. Specifically proposed is an extra year for primary care training with a single examination after four years, producing general internists with a primary care "minor." Alternately, and ideally, there would be a full two-year primary care fellowship with a separate internal medicine primary care subspecialty board examination. Either of the above options would provide necessary training and academic credibility for primary care internists, and would redirect internal medicine certification and training.

  8. Counselling in Primary Care: Past, Present, and Future.

    ERIC Educational Resources Information Center

    Eatock, John

    2000-01-01

    Presents a brief history of the growth of counseling in primary care. Discusses the challenges for primary care counselors and counseling, as well as the need for coordination, regulation and management. Also discusses the imperative for research support and the unique nature of counseling in primary care including challenges to its survival. (MKA)

  9. Gestational weight gain trajectories in primary care

    PubMed Central

    Piccinini-Vallis, Helena; Lee-Baggley, Dayna; Stewart, Moira; Ryan, Bridget

    2016-01-01

    Objective To identify gestational weight gain trajectories, stratified by prepregnancy body mass index (BMI), of women with singleton pregnancies who received prenatal care in a primary care setting, and to compare these trajectories with the 2009 Institute of Medicine gestational weight gain recommendations. Design Retrospective cohort study. Setting Halifax, NS. Participants Women who received prenatal care at the Dalhousie Family Medicine clinics in Halifax from 2009 to 2013. Main outcome measures For each prenatal visit, gestational age and weight measurements were obtained. Multilevel modeling was used to analyze the gestational weight gain trajectories. The upper limit of the guideline-recommended weekly gestational weight gain was compared with the 95% CI of the observed mean weekly gestational weight gain for each prepregnancy BMI category. Results A total of 280 women were included in the analyses. There was a significant interaction between prepregnancy BMI category and gestational weight gain over time (P < .001), with gestational weight gain being significantly lower among women with prepregnancy BMI of 30.0 kg/m2 or greater compared with those with BMI of 18.5 to less than 25.0 kg/m2 and 25.0 to less than 30.0 kg/m2. When comparing women’s weight gain with the recommendations, women with prepregnancy BMI of 25.0 to less than 30.0 kg/m2 had the most guideline discordance, deviating from the weight gain recommendations at 20 weeks’ gestation. Conclusion These results are relevant and of benefit to women and clinicians wishing to address excess gestational weight gain, and to researchers and policy makers developing interventions aimed at curbing gestational weight gain in primary care. Although our results showed women with prepregnancy BMI of 25.0 to less than 30.0 kg/m2 gained the most excess, guideline-discordant weight, interventions should target all women planning or experiencing a pregnancy.

  10. Competencies for psychology practice in primary care.

    PubMed

    McDaniel, Susan H; Grus, Catherine L; Cubic, Barbara A; Hunter, Christopher L; Kearney, Lisa K; Schuman, Catherine C; Karel, Michele J; Kessler, Rodger S; Larkin, Kevin T; McCutcheon, Stephen; Miller, Benjamin F; Nash, Justin; Qualls, Sara H; Connolly, Kathryn Sanders; Stancin, Terry; Stanton, Annette L; Sturm, Lynne A; Johnson, Suzanne Bennett

    2014-01-01

    This article reports on the outcome of a presidential initiative of 2012 American Psychological Association President Suzanne Bennett Johnson to delineate competencies for primary care (PC) psychology in six broad domains: science, systems, professionalism, relationships, application, and education. Essential knowledge, skills, and attitudes are described for each PC psychology competency. Two behavioral examples are provided to illustrate each competency. Clinical vignettes demonstrate the competencies in action. Delineation of these competencies is intended to inform education, practice, and research in PC psychology and efforts to further develop team-based competencies in PC.

  11. African Primary Care Research: Reviewing the literature

    PubMed Central

    Mash, Bob

    2014-01-01

    Abstract This is the second article in the series on African primary care research. The article focuses on how to search for relevant evidence in the published literature that can be used in the development of a research proposal. The article addresses the style of writing required and the nature of the arguments for the social and scientific value of the proposed study, as well as the use of literature in conceptual frameworks and in the methods. Finally, the article looks at how to keep track of the literature used and to reference it appropriately. PMID:26245433

  12. Sudden Sensorineural Hearing Loss: Primary Care Update.

    PubMed

    Leung, Marcia A; Flaherty, Anna; Zhang, Julia A; Hara, Jared; Barber, Wayne; Burgess, Lawrence

    2016-06-01

    The primary care physician's role in recognizing sudden sensorineural hearing (SSNHL) loss and delivering initial treatment is critical in the management of the syndrome. This role involves recognizing its clinical symptoms, distinguishing it from conductive hearing loss with the Weber tuning fork or the Rauch hum test, and urgent administration of high dose oral corticosteroids. Diagnosis and treatment should not be delayed for audiometric testing or referral to otolaryngology. This paper provides an update on the initial evaluation and treatment of this syndrome based on the literature and clinical guideline recommendations. PMID:27413627

  13. Primary Care of the Patient with Asthma.

    PubMed

    Lenaeus, Michael J; Hirschmann, Jan

    2015-09-01

    Obstructive lung disease includes asthma and chronic obstructive pulmonary disease (COPD). Because a previous issue of Medical Clinics of North America (2012;96[4]) was devoted to COPD, this article focuses on asthma in adults, and addresses some topics about COPD not addressed previously. Asthma is a heterogeneous disease marked by variable airflow obstruction and bronchial hyperreactivity. Onset is most common in early childhood, although many people develop asthma later in life. Adult-onset asthma presents a particular challenge in the primary care clinic because of incomplete understanding of the disorder, underreporting of symptoms, underdiagnosis, inadequate treatment, and high rate of comorbidity.

  14. Sudden Sensorineural Hearing Loss: Primary Care Update

    PubMed Central

    Leung, Marcia A; Flaherty, Anna; Zhang, Julia A; Hara, Jared; Barber, Wayne

    2016-01-01

    The primary care physician's role in recognizing sudden sensorineural hearing (SSNHL) loss and delivering initial treatment is critical in the management of the syndrome. This role involves recognizing its clinical symptoms, distinguishing it from conductive hearing loss with the Weber tuning fork or the Rauch hum test, and urgent administration of high dose oral corticosteroids. Diagnosis and treatment should not be delayed for audiometric testing or referral to otolaryngology. This paper provides an update on the initial evaluation and treatment of this syndrome based on the literature and clinical guideline recommendations. PMID:27413627

  15. Sudden Sensorineural Hearing Loss: Primary Care Update.

    PubMed

    Leung, Marcia A; Flaherty, Anna; Zhang, Julia A; Hara, Jared; Barber, Wayne; Burgess, Lawrence

    2016-06-01

    The primary care physician's role in recognizing sudden sensorineural hearing (SSNHL) loss and delivering initial treatment is critical in the management of the syndrome. This role involves recognizing its clinical symptoms, distinguishing it from conductive hearing loss with the Weber tuning fork or the Rauch hum test, and urgent administration of high dose oral corticosteroids. Diagnosis and treatment should not be delayed for audiometric testing or referral to otolaryngology. This paper provides an update on the initial evaluation and treatment of this syndrome based on the literature and clinical guideline recommendations.

  16. [Antimicrobial stewardship in primary care setting].

    PubMed

    Mombelli, Matteo; Plüss-Suard, Catherine; Niquille, Anne; Zanetti, Giorgio; Boillat-Blanco, Noémie

    2016-04-13

    Antibiotic overuse in primary care setting is a major contributor to the development of resistant bacteria. Antibiotic consumption is low in Switzerland compared to neighbour countries, but improvement is possible and has to be pursued. Antibiotic stewardship helps physician to better recognize patients who need antibiotic (guidelines implementation, electronic decision support and laboratory testing) and educate patients about the uselessness of antibiotics in a given situation (delayed prescription and shared decision making). Clinical studies demonstrated the efficacy of these interventions in reducing antibiotic consumption, mainly in acute respiratory infections, without affecting patients' clinical outcome.

  17. Routine programs of health care systems as an opportunity toward communication skills training for family physicians: A randomized field trial

    PubMed Central

    Zamani, Ahmad Reza; Motamedi, Narges; Farajzadegan, Ziba

    2015-01-01

    Background: To have high-quality primary health care services, an adequate doctor–patient communication is necessary. Because of time restrictions and limited budget in health system, an effective, feasible, and continuous training approach is important. The aim of this study is to assess the appropriateness of a communication skills training program simultaneously with routine programs of health care system. Materials and Methods: It was a randomized field trial in two health network settings during 2013. Twenty-eight family physicians through simple random sampling and 140 patients through convenience sampling participated as intervention and control group. The physicians in the intervention group (n = 14) attended six educational sessions, simultaneous organization meeting, with case discussion and peer education method. In both the groups, physicians completed communication skills knowledge and attitude questionnaires, and patients completed patient satisfaction of medical interview questionnaire at baseline, immediately after intervention, and four months postintervention. Physicians and health network administrators (stakeholders), completed a set of program evaluation forms. Descriptive statistics and Chi-square test, t-test, and repeated measure analysis of variance were used to analyze the data. Results: Use of routine program as a strategy of training was rated by stakeholders highly on “feasibility” (80.5%), “acceptability” (93.5%), “educational content and method appropriateness” (80.75%), and “ability to integrating in the health system programs” (approximate 60%). Significant improvements were found in physicians’ knowledge (P < 0.001), attitude (P < 0.001), and patients’ satisfaction (P = 0.002) in intervention group. Conclusions: Communication skills training program, simultaneous organization meeting was successfully implemented and well received by stakeholders, without considering extra time and manpower. Therefore it can be

  18. [The implementation of interdisciplinarity in the work routine of the family health care team].

    PubMed

    Scherer, Magda Duarte dos Anjos; de Pires, Denise Elvira Pires; Jean, Rémy

    2013-11-01

    Interdisciplinarity in the work routine of professionals of a Residency Course on Family Health in Southern Brazil was investigated in a qualitative study involving 11 residents and 5 supervisors of seven professions. Through interviews, observations and focal groups the existence of interdisciplinarity in practice was analyzed, duly identifying favorable and unfavorable aspects for its implementation. Interdisciplinarity was expressed as a complex process and concrete action, which occurs in the dramatic implications of its usage, in a dialectical relationship with the political and institutional context. The study revealed that working in family health care renders the work more complex and that the professionals experience difficulties in sharing knowledge and making the transition between multidisciplinarity and interdisciplinarity. The study concludes that interdisciplinarity requires the integrated use of knowledge in the multi-professional practice, the crossing of disciplinary boundaries, the development of competencies to address the challenges of the work environment and personal attitude as a basic component for professional action.

  19. Implementation of Health Information Technology in Routine Care for Fibromyalgia: Pilot Study.

    PubMed

    Sparks, Toni; Kawi, Jennifer; Menzel, Nancy Nivison; Hartley, Kendall

    2016-02-01

    Fibromyalgia management remains complicated and challenging. Health information technology is an evidence-based, nonpharmacological self and symptom management strategy, but few studies have evaluated its feasibility for managing fibromyalgia patients in clinical practice. FibroGuide is an example of an evidence-based, interactive, and computer-based program comprised of 10 educational modules on fibromyalgia. Study aims were to: (1) develop a process for implementing FibroGuide into the routine care of patients with fibromyalgia, (2) evaluate the overall impact on fibromyalgia before and after a 12-week implementation, and (3) assess patient perspectives on using FibroGuide health information technology to assist in self-management. In this pilot study, 35 participants with fibromyalgia were recruited from an Advanced Practice Registered Nurse's outpatient clinic. Using a descriptive design, quantitative data analysis was employed to address study aims. Based on data collection pre- and post-intervention using paired samples testing, a statistically significant change (p = .017) was observed in overall fibromyalgia impact (improved symptom severity, activity, and function). Majority felt that FibroGuide was helpful as part of their routine care, and nearly half reported that it assisted in their self-management. Although 65% noted that technology was an effective and efficient way to receive education for fibromyalgia management, 57% preferred talking to healthcare providers. Larger longitudinal studies are needed on the use of health information technology in fibromyalgia, evaluating both statistical and clinical significance, while decreasing barriers to participant use for this promising adjunct to clinical management. Providers need to be well educated on supporting self-management strategies and health information technology.

  20. Assessing primary care in Croatia: could it be moved forward?

    PubMed

    Keglević, Mladenka Vrcić; Kovačić, Luka; Pavleković, Gordana

    2014-12-01

    It is well known that countries with strong primary care achieve better health outcomes at lower costs. Therefore, the effort of World Health Organization in promoting primary care as a basic principal of successful health care system is an ongoing process. Although Croatia was recognized as a country with primary care orientation due to the development of health centers and introduction of specialist training of general practitioners, it seems that many health care reforms aimed at better organization of health institutions and decreasing of health care costs did not result with higher primary care orientation. By application of the Primary Care Score instrument in 2014 (Croatia received 11.2 out of 20 possible points), and international comparison performed in 2002, it was concluded that among the eighteen OECD countries Croatia could be categorized as an "intermediate primary care country", obtaining the scores just a bit above the average.

  1. A Participatory Model of the Paradox of Primary Care

    PubMed Central

    Homa, Laura; Rose, Johnie; Hovmand, Peter S.; Cherng, Sarah T.; Riolo, Rick L.; Kraus, Alison; Biswas, Anindita; Burgess, Kelly; Aungst, Heide; Stange, Kurt C.; Brown, Kalanthe; Brooks-Terry, Margaret; Dec, Ellen; Jackson, Brigid; Gilliam, Jules; Kikano, George E.; Reichsman, Ann; Schaadt, Debbie; Hilfer, Jamie; Ticknor, Christine; Tyler, Carl V.; Van der Meulen, Anna; Ways, Heather; Weinberger, Richard F.; Williams, Christine

    2015-01-01

    PURPOSE The paradox of primary care is the observation that primary care is associated with apparently low levels of evidence-based care for individual diseases, but systems based on primary care have healthier populations, use fewer resources, and have less health inequality. The purpose of this article is to explore, from a complex systems perspective, mechanisms that might account for the effects of primary care beyond disease-specific care. METHODS In an 8-session, participatory group model-building process, patient, caregiver, and primary care clinician community stakeholders worked with academic investigators to develop and refine an agent-based computer simulation model to test hypotheses about mechanisms by which features of primary care could affect health and health equity. RESULTS In the resulting model, patients are at risk for acute illness, acute life-changing illness, chronic illness, and mental illness. Patients have changeable health behaviors and care-seeking tendencies that relate to their living in advantaged or disadvantaged neighborhoods. There are 2 types of care available to patients: primary and specialty. Primary care in the model is less effective than specialty care in treating single diseases, but it has the ability to treat multiple diseases at once. Primary care also can provide disease prevention visits, help patients improve their health behaviors, refer to specialty care, and develop relationships with patients that cause them to lower their threshold for seeking care. In a model run with primary care features turned off, primary care patients have poorer health. In a model run with all primary care features turned on, their conjoint effect leads to better population health for patients who seek primary care, with the primary care effect being particularly pronounced for patients who are disadvantaged and patients with multiple chronic conditions. Primary care leads to more total health care visits that are due to more disease

  2. [Clinical case: Complicated grief in primary care. Care plan].

    PubMed

    Ruymán Brito-Brito, Pedro; Rodríguez-Ramos, Mercedes; Pérez-García-Talavera, Carlos

    2009-01-01

    This is the case of a 61-year-old patient woman that visits her nurse in Primary Health Care to get the control of blood pressure and glycemia. In the last two years has suffered the loss of her husband and of two brothers beside having lived through other vital stressful events that have taken her to a situation of complicated grief. The care plan is realized using the M. Gordon assessment system and standardized languages NANDA, NOC and NIC. The principal aims were the improvement of the depression level and the improvement in the affliction resolution. As suggested interventions were proposed to facilitate the grief and the derivation to a mental health unit. A follow-up of the patient was realized in nursing consultation at Primary health care to weekly intervals, in the beginning, and monthly, later. The evaluation of the care plan reflects an improvement in the criteria of Prigerson's complicated grief; an increase of the recreative activities; the retreat of the mourning that still she was guarding; as well as an improvement in the control of the blood pressure numbers. The attention of nurses before a case of complicated grief turns out to be complex. Nevertheless the suitable accomplishment of certain interventions orientated to facilitating the grief, with a follow-up in consultation, shows the efficiency. The difficulty in the boarding of the psychosocial problems meets increased at the moment of are necessary the nursing diagnostics adapted for every individual case. The work in group between nurses could improves the consensus.

  3. Mental health screening among newly arrived refugees seeking routine obstetric and gynecologic care.

    PubMed

    Johnson-Agbakwu, Crista E; Allen, Jennifer; Nizigiyimana, Jeanne F; Ramirez, Glenda; Hollifield, Michael

    2014-11-01

    Posttraumatic stress disorder (PTSD), anxiety, and depression are common mental health disorders in the refugee population. High rates of violence, trauma, and PTSD among refugee women remain unaddressed. The process of implementing a mental health screening tool among multiethnic, newly arrived refugee women receiving routine obstetric and gynecologic care in a dedicated refugee women's health clinic is described. The Refugee Health Screener-15 (RHS-15) is a culturally responsive, efficient, validated screening instrument that detects symptoms of emotional distress across diverse refugee populations and languages. An interdisciplinary community partnership was established with a local behavioral health services agency to facilitate the referral of women scoring positive on the RHS-15. Staff and provider training sessions, as well as the incorporation of bicultural, multilingual cultural health navigators, greatly facilitated linguistically appropriate care coordination for refugee women in a culturally sensitive manner. Twenty-six (23.2%) of the 112 women who completed the RHS-15 scored positive, of which 14 (53.8%) were Iraqi, 1 (3.8%) was Burmese, and 3 (11.5%) were Somali. Among these 26 women, 8 (30.8%) are actively receiving mental health services and 5 (19.2%) have appointments scheduled. However, 13 (50%) are not enrolled in mental health care because of either declining services (46.2%) or a lack of insurance (53.8%). Screening for mental disorders among refugee women will promote greater awareness and identify those individuals who would benefit from further mental health evaluation and treatment. Sustainable interdisciplinary models of care are necessary to promote health education, dispel myths, and reduce the stigma of mental health.

  4. Mental Health Screening Among Newly-Arrived Refugees Seeking Routine Obstetric and Gynecologic Care

    PubMed Central

    Johnson-Agbakwu, Crista E.; Allen, Jennifer; Nizigiyimana, Jeanne F.; Ramirez, Glenda; Hollifield, Michael

    2014-01-01

    Posttraumatic stress disorder (PTSD), anxiety, and depression are the most common mental health disorders in the refugee population. High rates of violence, trauma, and PTSD among refugee women remain unaddressed. The process of implementing a mental health screening tool among multi-ethnic, newly-arrived refugee women receiving routine obstetric and gynecologic care in a dedicated refugee women’s health clinic is described. The Refugee Health Screener-15 (RHS-15) is a culturally-responsive, efficient, validated screening instrument that detects symptoms of emotional distress across diverse refugee populations and languages. An interdisciplinary community partnership was established with a local behavioral health services agency to facilitate the referral of women scoring positive on the RHS-15. Staff and provider training sessions, as well as the incorporation of bi-cultural, multi-lingual Cultural Health Navigators, greatly facilitated linguistically-appropriate care coordination for refugee women in a culturally sensitive manner. Twenty-six (23.2%) of the 112 women who completed the RHS-15 scored positive; of which 14 (53.8%) were Iraqi, one (3.8%) was Burmese, and three (11.5%) were Somali. Among these 26 women, eight (30.8%) are actively receiving mental health services, and five (19.2%) have appointments scheduled. However 13 (50%) are not enrolled in mental health care due to either declining services (46.2%), or a lack of insurance (53.8%). Screening for mental disorders among refugee women will promote greater awareness and identify those individuals who would benefit from further mental health evaluation and treatment. Sustainable interdisciplinary models of care are necessary to promote health education, dispel myths and reduce the stigma of mental health. PMID:25383999

  5. Approach to traumatic hand injuries for primary care physicians

    PubMed Central

    Cheung, Kevin; Hatchell, Alexandra; Thoma, Achilleas

    2013-01-01

    Abstract Objective To review the initial management of common traumatic hand injuries seen by primary care physicians. Sources of information Current clinical evidence and literature identified through MEDLINE electronic database searches was reviewed. Expert opinion was used to supplement recommendations for areas with little evidence. Main message Primary care physicians must routinely manage patients with acute traumatic hand injuries. In the context of a clinical case, we review the assessment, diagnosis, and initial management of common traumatic hand injuries. The presentation and management of nail bed injuries, fingertip amputations, mallet fingers, hand fractures, tendon lacerations, bite injuries, and infectious tenosynovitis will also be discussed. The principles of managing traumatic hand injuries involve the reduction and immobilization of fractures, obtaining post-reduction x-ray scans, obtaining soft tissue coverage, preventing and treating infection, and ensuring tetanus prophylaxis. Conclusion Proper assessment and management of traumatic hand injuries is essential to prevent substantial long-term morbidity in this generally otherwise healthy population. Early recognition of injuries that require urgent or emergent referral to a hand surgeon is critical. PMID:23766041

  6. [Use of probiotics and prebiotics in primary care].

    PubMed

    Álvarez Calatayud, Guillermo; Azpiroz, Fernando

    2015-02-07

    Probiotics are used in a great number of both paediatric and adult diseases, mainly in gastrointestinal disorders, like diarrhoea. Nevertheless, their beneficial effect on immune alterations, such as atopic dermatitis and, more recently, in women related diseases such as vulvovaginitis and mastitis have also been observed. However, the use of probiotics is not completely implemented into the routine clinical practice for primary care physicians. There is still a great controversy with scarce scientific evidence, due to the diversity in the designs thereof which justifies the variability in the efficacy results. This outcome leads to difficulties in developing definitive treatment guidelines although there are exceptions, for example, WGO. The aim of this workshop, held at the VI Congress of the Spanish Society of Probiotics and Prebiotics is the training of primary care physicians, both paediatricians and general practitioners in the clinical applications of these nutritional preparations in different diseases: acute diarrhoea; antibiotic associated diarrhoea, necrotizing enterocolitis, employment in infant milk formulas, infant colic, irritable bowel syndrome and inflammatory bowel disease, as well as vulvovaginitis and mastitis.

  7. Effect of opioid prescribing guidelines in primary care.

    PubMed

    Chen, Jonathan H; Hom, Jason; Richman, Ilana; Asch, Steven M; Podchiyska, Tanya; Johansen, Nawal Atwan

    2016-08-01

    Long-term opioid use for noncancer pain is increasingly prevalent yet controversial given the risks of addiction, diversion, and overdose. Prior literature has identified the problem and proposed management guidelines, but limited evidence exists on the actual effectiveness of implementing such guidelines in a primary care setting.A multidisciplinary working group of institutional experts assembled comprehensive guidelines for chronic opioid prescribing, including monitoring and referral recommendations. The guidelines were disseminated in September 2013 to our medical center's primary care clinics via in person and electronic education.We extracted electronic medical records for patients with noncancer pain receiving opioid prescriptions (Rxs) in seasonally matched preintervention (11/1/2012-6/1/2013) and postintervention (11/1/2013-6/1/2014) periods. For patients receiving chronic (3 or more) opioid Rxs, we assessed the rates of drug screening, specialty referrals, clinic visits, emergency room visits, and quantity of opioids prescribed.After disseminating guidelines, the percentage of noncancer clinic patients receiving any opioid Rxs dropped from 3.9% to 3.4% (P = 0.02). The percentage of noncancer patients receiving chronic opioid Rxs decreased from 2.0% to 1.6% (P = 0.03). The rate of urine drug screening increased from 9.2% to 17.3% (P = 0.005) amongst noncancer chronic opioid patients. No significant differences were detected for other metrics or demographics assessed.An educational intervention for primary care opioid prescribing is feasible and was temporally associated with a modest reduction in overall opioid Rx rates. Provider use of routine drug screening increased, but overall rates of screening and specialty referral remained low despite the intervention. Despite national pressures to introduce opioid prescribing guidelines for chronic pain, doing so alone does not necessarily yield substantial changes in clinical practice. PMID:27583928

  8. Effect of opioid prescribing guidelines in primary care.

    PubMed

    Chen, Jonathan H; Hom, Jason; Richman, Ilana; Asch, Steven M; Podchiyska, Tanya; Johansen, Nawal Atwan

    2016-08-01

    Long-term opioid use for noncancer pain is increasingly prevalent yet controversial given the risks of addiction, diversion, and overdose. Prior literature has identified the problem and proposed management guidelines, but limited evidence exists on the actual effectiveness of implementing such guidelines in a primary care setting.A multidisciplinary working group of institutional experts assembled comprehensive guidelines for chronic opioid prescribing, including monitoring and referral recommendations. The guidelines were disseminated in September 2013 to our medical center's primary care clinics via in person and electronic education.We extracted electronic medical records for patients with noncancer pain receiving opioid prescriptions (Rxs) in seasonally matched preintervention (11/1/2012-6/1/2013) and postintervention (11/1/2013-6/1/2014) periods. For patients receiving chronic (3 or more) opioid Rxs, we assessed the rates of drug screening, specialty referrals, clinic visits, emergency room visits, and quantity of opioids prescribed.After disseminating guidelines, the percentage of noncancer clinic patients receiving any opioid Rxs dropped from 3.9% to 3.4% (P = 0.02). The percentage of noncancer patients receiving chronic opioid Rxs decreased from 2.0% to 1.6% (P = 0.03). The rate of urine drug screening increased from 9.2% to 17.3% (P = 0.005) amongst noncancer chronic opioid patients. No significant differences were detected for other metrics or demographics assessed.An educational intervention for primary care opioid prescribing is feasible and was temporally associated with a modest reduction in overall opioid Rx rates. Provider use of routine drug screening increased, but overall rates of screening and specialty referral remained low despite the intervention. Despite national pressures to introduce opioid prescribing guidelines for chronic pain, doing so alone does not necessarily yield substantial changes in clinical practice.

  9. Effect of opioid prescribing guidelines in primary care

    PubMed Central

    Chen, Jonathan H.; Hom, Jason; Richman, Ilana; Asch, Steven M.; Podchiyska, Tanya; Johansen, Nawal Atwan

    2016-01-01

    Abstract Long-term opioid use for noncancer pain is increasingly prevalent yet controversial given the risks of addiction, diversion, and overdose. Prior literature has identified the problem and proposed management guidelines, but limited evidence exists on the actual effectiveness of implementing such guidelines in a primary care setting. A multidisciplinary working group of institutional experts assembled comprehensive guidelines for chronic opioid prescribing, including monitoring and referral recommendations. The guidelines were disseminated in September 2013 to our medical center's primary care clinics via in person and electronic education. We extracted electronic medical records for patients with noncancer pain receiving opioid prescriptions (Rxs) in seasonally matched preintervention (11/1/2012–6/1/2013) and postintervention (11/1/2013–6/1/2014) periods. For patients receiving chronic (3 or more) opioid Rxs, we assessed the rates of drug screening, specialty referrals, clinic visits, emergency room visits, and quantity of opioids prescribed. After disseminating guidelines, the percentage of noncancer clinic patients receiving any opioid Rxs dropped from 3.9% to 3.4% (P = 0.02). The percentage of noncancer patients receiving chronic opioid Rxs decreased from 2.0% to 1.6% (P = 0.03). The rate of urine drug screening increased from 9.2% to 17.3% (P = 0.005) amongst noncancer chronic opioid patients. No significant differences were detected for other metrics or demographics assessed. An educational intervention for primary care opioid prescribing is feasible and was temporally associated with a modest reduction in overall opioid Rx rates. Provider use of routine drug screening increased, but overall rates of screening and specialty referral remained low despite the intervention. Despite national pressures to introduce opioid prescribing guidelines for chronic pain, doing so alone does not necessarily yield substantial changes in clinical

  10. [Urine incontinence referral criteria for primary care].

    PubMed

    Brenes Bermúdez, F J; Cozar Olmo, J M; Esteban Fuertes, M; Fernández-Pro Ledesma, A; Molero García, J M

    2013-01-01

    Despite the high incidence of urinary incontinence (UI), health professional awareness of this disease is low, which in itself is not serious but significantly limits the lives of the patients. The Primary Care associations, Sociedad Española de Médicos de Atención Primaria [SEMERGEN], Sociedad Española de Médicos Generales y de Familia [SEMG], Sociedad Española de Medicina de Familia y Comunitaria [semFYC]) along with the Asociación Española de Urología (EAU) have developed this consensus with the proposal of making GPs aware, and to help them in the diagnosis, treatment and referral to Urologists. The first goal in primary care must be the detection of UI, thus an opportunistic screening at least once in the lifetime of asymptomatic women > 40 years old and asymptomatic men > 55 years old. The diagnosis, based on medical history and physical examination, must determine the type and severity of the UI in order to refer severe cases to the Urologist. Except for overactive bladder (OAB), non-pharmacological conservative treatment is the first approach to uncomplicated UI in females and males. Antimuscarinics are the only drugs that have demonstrated efficacy and safety in urge urinary incontinence (UUI) and OAB. In men with mixed symptoms, excluding severe obstruction cases, a combination therapy of alpha-blockers and antimuscarinics should be chosen.

  11. [Urine incontinence referral criteria for primary care].

    PubMed

    Brenes Bermúdez, F J; Cozar Olmo, J M; Esteban Fuertes, M; Fernández-Pro Ledesma, A; Molero García, J M

    2013-05-01

    Despite the high incidence of urinary incontinence (UI), health professional awareness of this disease is low, which in itself is not serious but significantly limits the lives of the patients. The Primary Care associations, Sociedad Española de Médicos de Atención Primaria [SEMERGEN], Sociedad Española de Médicos Generales y de Familia [SEMG], Sociedad Española de Medicina de Familia y Comunitaria [semFYC]) along with the Asociación Española de Urología (EAU) have developed this consensus with the proposal of making GPs aware, and to help them in the diagnosis, treatment and referral to Urologists. The first goal in primary care must be the detection of UI, thus an opportunistic screening at least once in the lifetime of asymptomatic women > 40 years old and asymptomatic men > 55 years old. The diagnosis, based on medical history and physical examination, must determine the type and severity of the UI in order to refer severe cases to the Urologist. Except for overactive bladder (OAB), non-pharmacological conservative treatment is the first approach to uncomplicated UI in females and males. Antimuscarinics are the only drugs that have demonstrated efficacy and safety in urge urinary incontinence (UUI) and OAB. In men with mixed symptoms, excluding severe obstruction cases, a combination therapy of alpha-blockers and antimuscarinics should be chosen.

  12. [Patient safety in primary care: PREFASEG project].

    PubMed

    Catalán, Arantxa; Borrell, Francesc; Pons, Angels; Amado, Ester; Baena, José Miguel; Morales, Vicente

    2014-07-01

    The Institut Català de la Salut (ICS) has designed and integrated in electronic clinical station of primary care a new software tool to support the prescription of drugs, which can detect on-line certain medication errors. The software called PREFASEG (stands for Secure drug prescriptions) aims to prevent adverse events related to medication use in the field of primary health care (PHC). This study was made on the computerized medical record called CPT, which is used by all PHC physicians in our institution -3,750- and prescribing physicians through it. PREFASEG integrated in eCAP in July 2010 and six months later we performed a cross-sectional study to evaluate their usefulness and refine their design. The software alerts on-line in 5 dimensions: drug interactions, redundant treatments, allergies, contraindications of drugs with disease, and advises against drugs in over 75 years. PREFASEG generated 1,162,765 alerts (1 per 10 high treatment), with the detection of therapeutic duplication (62%) the most alerted. The overall acceptance rate is 35%, redundancies pharmacological (43%) and allergies (26%) are the most accepted. A total of 10,808 professionals (doctors and nurses) have accepted some of the recommendations of the program. PREFASEG is a feasible and highly efficient strategy to achieve an objective of Quality Plan for the NHS.

  13. ADHD in school-aged youth: Management and special treatment considerations in the primary care setting.

    PubMed

    Weed, Elizabeth D

    2016-01-01

    Attention-deficit/hyperactivity disorder is considered one of the most common neurodevelopmental disorders of childhood. Primary care providers are in the unique position of providing comprehensive care-routine care, well child visits, immunizations, and other healthcare needs-to a majority of children and adolescents with attention-deficit/hyperactivity disorder. As such, primary care providers are pivotal in the diagnosis, management, and treatment of this population. This article will address special treatment considerations to aid in the management of attention-deficit/hyperactivity disorder in the primary care setting, including substance use disorders and diversion, cardiac issues and stimulant medication, medication holidays and follow-up monitoring. The database of PubMed was searched using keywords that included attention-deficit/hyperactivity disorder, children, prevalence, medication holidays, safety, cardiovascular, cardiac, blood pressure, substance use, diversion, adverse drug reactions; inclusion dates were January 1, 2011 to September 30, 2015.

  14. Integrating smoking cessation into routine public prenatal care: the Smoking Cessation in Pregnancy project.

    PubMed Central

    Kendrick, J S; Zahniser, S C; Miller, N; Salas, N; Stine, J; Gargiullo, P M; Floyd, R L; Spierto, F W; Sexton, M; Metzger, R W

    1995-01-01

    OBJECTIVES. In 1986, the state health departments of Colorado, Maryland, and Missouri conducted a federally-funded demonstration project to increase smoking cessation among pregnant women receiving prenatal care and services from the Women, Infants, and Children (WIC) program in public clinics. METHODS. Low-intensity interventions were designed to be integrated into routine prenatal care. Clinics were randomly assigned to intervention or control status; pregnant smokers filled out questionnaires and gave urine specimens at enrollment, in the eighth month of pregnancy, and postpartum. Urine cotinine concentrations were determined at CDC by enzyme-linked immunosorbent assay and were used to verify self-reported smoking status. RESULTS. At the eighth month of pregnancy, self-reported quitting was higher for intervention clinics than control clinics in all three states. However, the cotinine-verified quit rates were not significantly different. CONCLUSIONS. Biochemical verification of self-reported quitting is essential to the evaluation of smoking cessation interventions. Achieving changes in smoking behavior in pregnant women with low-intensity interventions is difficult. PMID:7856781

  15. Reflections on the past and future of primary care.

    PubMed

    Howell, Joel D

    2010-05-01

    Medical care and primary care were at one time synonymous. All health care was primary. The concept and terminology of primary care came into widespread use during the 1960s, reflecting a specific policy agenda: bolstering the role of the generalist physician, which had changed dramatically following World War II. This essay describes the transformation of the nineteenth-century physician making house calls on horseback into the twenty-first-century primary care physician contemplating the electronic records of her patient population. The essential point is that "primary care" was born out of tension with other forms of medical care. In the future, primary care will be reinvented, and changes will be caused by the sorts of external social, political, and economic forces that previously led to systemic transformation. PMID:20439858

  16. Health promotion and primary health care: examining the discourse.

    PubMed

    Ashcroft, Rachelle

    2015-01-01

    The health promotion discourse is comprised of assumptions about health and health care that are compatible with primary health care. An examination of the health promotion discourse illustrates how assumptions of health can help to inform primary health care. Despite health promotion being a good fit for primary health care, this analysis demonstrates that the scope in which it is being implemented in primary health care settings is limited. The health promotion discourse appears largely compatible with primary health care-in theory and in the health care practices that follow. The aim of this article is to contribute to the advancement of theoretical understanding of the health promotion discourse, and the relevance of health promotion to primary health care.

  17. The Road to Excellence for Primary Care Resident Teaching Clinics.

    PubMed

    Gupta, Reena; Dubé, Kate; Bodenheimer, Thomas

    2016-04-01

    Primary care residency programs and their associated primary care clinics face challenges in their goal to simultaneously provide a good education for tomorrow's doctors and excellent care for today's patients. A team from the Center for Excellence in Primary Care at the University of California, San Francisco, conducted site visits to 23 family medicine, internal medicine, and pediatric residency teaching clinics. The authors found that a number of programs have transformed themselves with respect to engaged leadership, resident scheduling, continuity of care for patients and residents, team-based care, and resident engagement in practice improvement. In this Commentary, the authors highlight the features of transforming programs that are melding inspiring resident education with excellent patient care. The authors propose a model, the 10 + 3 Building Blocks of Primary Care Teaching Clinics, to illustrate the themes that characterize transforming primary care residency programs. PMID:26826073

  18. The Road to Excellence for Primary Care Resident Teaching Clinics.

    PubMed

    Gupta, Reena; Dubé, Kate; Bodenheimer, Thomas

    2016-04-01

    Primary care residency programs and their associated primary care clinics face challenges in their goal to simultaneously provide a good education for tomorrow's doctors and excellent care for today's patients. A team from the Center for Excellence in Primary Care at the University of California, San Francisco, conducted site visits to 23 family medicine, internal medicine, and pediatric residency teaching clinics. The authors found that a number of programs have transformed themselves with respect to engaged leadership, resident scheduling, continuity of care for patients and residents, team-based care, and resident engagement in practice improvement. In this Commentary, the authors highlight the features of transforming programs that are melding inspiring resident education with excellent patient care. The authors propose a model, the 10 + 3 Building Blocks of Primary Care Teaching Clinics, to illustrate the themes that characterize transforming primary care residency programs.

  19. Comparative Effectiveness of Five Smoking Cessation Pharmacotherapies in Primary Care Clinics

    PubMed Central

    Smith, Stevens S.; McCarthy, Danielle E.; Japuntich, Sandra J.; Christiansen, Bruce; Piper, Megan E.; Jorenby, Douglas E.; Fraser, David L.; Fiore, Michael C.; Baker, Timothy B.; Jackson, Thomas C.

    2010-01-01

    Background Randomized efficacy clinical trials conducted in research settings may not accurately reflect the benefits of tobacco dependence treatments when used in real-world clinical settings. Effectiveness trials (e.g., in primary care settings) are needed to estimate the benefits of cessation treatments in real-world use. Methods 1346 primary care patients attending routine appointments were recruited by medical assistants in 12 primary care clinics. Patients were randomly assigned to five active pharmacotherapies: three monotherapies (Nicotine Patch, Nicotine Lozenge, and Bupropion SR) and two combination therapies (Patch+Lozenge and Bupropion+Lozenge). Patients were referred to a telephone quitline for cessation counseling. Primary outcomes included seven-day point-prevalence abstinence at one week, eight weeks, and six months post-quit, and number of days to relapse. Results Among 7128 eligible smokers (≥ 10 cigarettes per day) attending routine primary care appointments, 19% (N=1346) enrolled in the study. Six month abstinence rates were: Bupropion=16.8%; Lozenge=19.9%; Patch=17.7%; Patch+Lozenge=26.9%; and Bupropion+Lozenge=29.9%. Bupropion SR+Lozenge was superior to all of the monotherapies (odds ratios [ORs]: 0.46 to 0.56); Patch+Lozenge was superior to Patch and Bupropion monotherapies (ORs: 0.56 and 0.54, respectively). Conclusions One in five smokers attending a routine primary care appointment was willing to make a serious quit attempt that included evidence-based counseling and medication. In this comparative effectiveness study of five tobacco dependence treatments, combination pharmacotherapy significantly increased abstinence compared to monotherapies. Provision of free cessation medications plus quitline counseling arranged in the primary care setting holds promise for assisting large numbers of smokers to quit. PMID:20008701

  20. Primary care as a platform for full continuum health care risk management.

    PubMed

    Klepper, Brian

    2013-01-01

    Health care clinical and financial risk is a multivectored problem, requiring multivectored solutions that extend beyond primary care. Worksite clinics have emerged that leverage empowered primary care, but incorporate a range of tactics aimed at driving appropriate care and cost by disrupting health care's perverse incentives. This article describes some of those approaches and shows evidence of the performance that can result. PMID:24402068

  1. 'Fried chicken' medicine: the business of primary care.

    PubMed

    Culley, G A

    1994-01-01

    The current environment of pressures for health care reform have created a renewed interest in primary health care delivery. In most health care reform scenarios, family physicians and other primary care doctors are the case managers for all health care delivery. At the same time, there are intense activities from investment banking firms, insurance companies, hospitals, and home health companies, directed toward the purchase of primary care practices and organizing primary care delivery systems. These organizations seek to profit either from ancillary services generated by primary care or from capitation for a population of managed-care patients. Based on personal employment experiences with a for-profit hospital company, the author illustrates the difficulty in developing and managing primary care as a business and the inevitable conflict between management and primary care physicians. The article has detailed advice for family physicians to aid them in carefully examining organizational culture, financial structuring, physician relations, and operational aspects of any for-profit or hospital primary care system before deciding to become part of it. PMID:8289054

  2. 'Fried chicken' medicine: the business of primary care.

    PubMed

    Culley, G A

    1994-01-01

    The current environment of pressures for health care reform have created a renewed interest in primary health care delivery. In most health care reform scenarios, family physicians and other primary care doctors are the case managers for all health care delivery. At the same time, there are intense activities from investment banking firms, insurance companies, hospitals, and home health companies, directed toward the purchase of primary care practices and organizing primary care delivery systems. These organizations seek to profit either from ancillary services generated by primary care or from capitation for a population of managed-care patients. Based on personal employment experiences with a for-profit hospital company, the author illustrates the difficulty in developing and managing primary care as a business and the inevitable conflict between management and primary care physicians. The article has detailed advice for family physicians to aid them in carefully examining organizational culture, financial structuring, physician relations, and operational aspects of any for-profit or hospital primary care system before deciding to become part of it.

  3. Barriers to the routine collection of health outcome data in an Australian community care organization

    PubMed Central

    Nancarrow, Susan A

    2013-01-01

    For over a decade, organizations have attempted to include the measurement and reporting of health outcome data in contractual agreements between funders and health service providers, but few have succeeded. This research explores the utility of collecting health outcomes data that could be included in funding contracts for an Australian Community Care Organisation (CCO). An action-research methodology was used to trial the implementation of outcome measurement in six diverse projects within the CCO using a taxonomy of interventions based on the International Classification of Function. The findings from the six projects are presented as vignettes to illustrate the issues around the routine collection of health outcomes in each case. Data collection and analyses were structured around Donabedian’s structure–process–outcome triad. Health outcomes are commonly defined as a change in health status that is attributable to an intervention. This definition assumes that a change in health status can be defined and measured objectively; the intervention can be defined; the change in health status is attributable to the intervention; and that the health outcomes data are accessible. This study found flaws with all of these assumptions that seriously undermine the ability of community-based organizations to introduce routine health outcome measurement. Challenges were identified across all stages of the Donabedian triad, including poor adherence to minimum dataset requirements; difficulties standardizing processes or defining interventions; low rates of use of outcome tools; lack of value of the tools to the service provider; difficulties defining or identifying the end point of an intervention; technical and ethical barriers to accessing data; a lack of standardized processes; and time lags for the collection of data. In no case was the use of outcome measures sustained by any of the teams, although some quality-assurance measures were introduced as a result of the

  4. Primary care for young African American men.

    PubMed

    Rich, J A

    2001-01-01

    Young African American men in the inner city have higher rates of mortality and morbidity from potentially preventable causes than other American men of the same age. They suffer disproportionately high rates of preventable illness from violence, sexually transmitted diseases, and HIV infection. These young men present with problems related to sexual concerns, mental health issues, substance abuse, and violence. They also report substantial risk-taking behaviors, including unprotected sex, substance use, and weapon carrying, as well as exposure to violence. Access to and use of preventive primary care services has been limited for these patients in the past because of financial barriers and competing social issues. Racism and historical oppression have created barriers of mistrust for young men of color. Factors that contribute to their adverse health status, as well as ways to address these problems, are discussed.

  5. Addressing suicidality in primary care settings.

    PubMed

    Bostwick, J Michael; Rackley, Sandra

    2012-08-01

    By design or by default, primary care providers (PCPs)are frequently the vanguard in the fight against suicide. Recent studies have highlighted programs to improve screening and prevention of suicidality in the medical home, particularly among high-risk patients, such as adolescents, the elderly, and veterans. Increasing efforts are also being paid to improving the PCP's skill in assessing for suicidality. However, it is becoming increasingly apparent that screening alone will not significantly lower suicide rates until it occurs within a well-integrated system that facilitates timely referral to more intensive mental health services for those patients who need them. Unfortunately, such systems are sorely lacking in many, if not most, areas of the USA. PMID:22644310

  6. [Shigellosis in a primary care practice].

    PubMed

    Ben-Noun, L; Shvartzman, P

    1994-11-15

    The epidemiological and clinical characteristics of 47 patients infected with Shigella in 3436 patients at a primary care clinic during 30 months were reviewed. Most cases were seen during the winter. The prominent clinical features were abdominal pain (91.5%), headaches (72.5%), bloody diarrhea (66%), mucoid stools (63.8%), fever (53.2%) and 75% had 4-10 stools per day. Most patients presented the first day of the illness (75%). S. sonnei has been found the most prevalent among 4 types of shigella. Resistance to ampicillin was complete and to Resprim 95%, but to nalidixic acid and to tetracycline, 4.9%. A third of the patients were treated with oral fluids and an appropriate diet and 2/3 received antibiotics. Children between 1-4 years of age who attend kindergartens are the main risk group for Shigellosis. PMID:7995566

  7. Detection of insomnia in primary care.

    PubMed

    Doghramji, P P

    2001-01-01

    Insomnia is a widespread condition with diverse presentations. Detection and diagnosis of insomnia present a particular challenge to the primary care physician. Patients seldom identify their sleep habits as the source of the complaints for which they are seeking treatment. Insomnia may be the result of many different medical or psychiatric illnesses or the side effects of medications or legal or illegal recreational drugs. Insomnia has a serious impact on daily activities and can cause serious or fatal injuries. With ever-increasing competition with sleep from 24-hour television broadcasts from hundreds of channels and the Internet, as well as more traditional distractions of late-night movies, clubs, and bars, we have become a society that sleeps 25% less than our ancestors did a century ago. We have no evidence, however, that we require less sleep than they did. This article presents strategies for detecting and diagnosing insomnia.

  8. Transplantation and the primary care physician.

    PubMed

    McGill, Rita L; Ko, Tina Y

    2011-11-01

    Increasing appreciation of the survival benefits of kidney transplantation, compared with chronic dialysis, has resulted in more patients with kidney disease being referred and receiving organs. The evolving disparity between a rapidly increasing pool of candidates and a smaller pool of available donors has created new issues for the physicians who care for kidney patients and their potential living donors. This article outlines current efforts to address the growing number of patients who await transplantation, including relaxation of traditional donation criteria, maximization of living donation, and donation schemas that permit incompatible donor-recipient pairs to participate through paired donation and transplantation chains. New ethical issues faced by donors and recipients are discussed. Surgical advances that reduce the morbidity of donors are also described, as is the role of the primary physician in medical issues of both donors and recipients. PMID:22098662

  9. Drinking Motives Among HIV Primary Care Patients

    PubMed Central

    Elliott, Jennifer C.; Aharonovich, Efrat; O’Leary, Ann; Wainberg, Milton; Hasin, Deborah

    2013-01-01

    Heavy drinking among individuals with HIV is associated with poor medication adherence and other health problems. Understanding reasons for drinking (drinking motives) in this population is therefore important and could inform intervention. Using concepts of drinking motives from previous alcohol research, we assessed these motives and drinking in 254 HIV-positive primary care patients (78.0% male; 94.5% African American or Hispanic) prior to their participation in an alcohol intervention trial. Three motives had good factor structure and internal consistency: “drinking to cope with negative affect”, “drinking for social facilitation” (both associated with heavier drinking), and “drinking due to social pressure” (associated with less drinking). Drinking motives may provide important content for alcohol intervention; clinical trials could indicate whether inclusion of such content improves intervention efficacy. Discussing motives in session could help providers assist clients in better managing psychological and social aspects of their lives without reliance on alcohol. PMID:24165984

  10. [Hoarseness from the viewpoint of primary care].

    PubMed

    Järhult, B; Persson, G B; Valeur, E

    1983-01-01

    Hoarseness is a symptom that is constantly encountered by doctors in primary care. It is the leading symptom in acute laryngitis and is often present as one of the symptoms in, for example, respiratory tract infections, influenza, and bronchitis. For the general practitioner, the infection factor as the cause of hoarseness is so dominant that other possible causes may fail to be taken into consideration. The general practitioner's possibilities for diagnosing the cause of this symptom are largely determined by habit, and by his ability to observe and assess the vocal chords. Examination of the vocal chords is often technically difficult, and patients in whom inspection presents difficulties should be remitted to an ear specialist. Hoarse smokers constitute a special group at risk, and these patients should be remitted for further examinations, if the general practitioner finds it hard to make a complete inspection of the chords. The article also describes an investigation on how hoarseness is handled at a health centre.

  11. Disparities in Primary Care EHR Adoption Rates

    PubMed Central

    Mack, Dominic; Zhang, Shun; Douglas, Megan; Sow, Charles; Strothers, Harry; Rust, George

    2016-01-01

    This study evaluates electronic health record (EHR) adoption by primary care providers in Georgia to assess adoption disparities according to practice size and type, payer mix, and community characteristics. Frequency variances of EHR “Go Live” status were estimated. Odds ratios were calculated by univariate and multivariate logistic regression models. Large practices and community health centers (CHCs) were more likely to Go Live (>80% EHR adoption) than rural health clinics and other underserved settings (53%). A significantly lower proportion (68.9%) of Medicaid predominant providers had achieved Go Live status and had a 47% higher risk of not achieving Go Live status than private insurance predominant practices. Disparities in EHR adoption rates may exacerbate existing disparities in health outcomes of patients served by these practices. Targeted support such as that provided to CHCs would level the playing field for practices now at a disadvantage. PMID:27587942

  12. Australia's primary health care workforce--research informing policy.

    PubMed

    Douglas, Kirsty A; Rayner, Frith K; Yen, Laurann E; Wells, Robert W; Glasgow, Nicholas J; Humphreys, John S

    2009-07-20

    In 2008, the Australian Primary Health Care Research Institute (APHCRI) held a Primary Health Care Workforce Roundtable with practising clinicians, policymakers and researchers, which drew on Australian evidence in health care policy, systematic reviews, and expertise and experience of participants. Key recommendations for an adequate, sustainable and effective primary health care workforce that arose from the meeting included: simplifying the Medicare Benefits Schedule, which is unnecessarily complex and inflexible; effectively funding undergraduate and prevocational medical and nursing education and training in primary health care; developing career structure and training pathways for general practitioners and primary health care nurses; developing of functional primary health care teams; and using a blended funding model, comprising fee-for-service as well as capitation for patients with chronic or complex needs. A report from the meeting, detailing these policy options, was submitted to the National Health and Hospitals Reform Commission for inclusion in their deliberations. PMID:19619091

  13. A primary health care project in Sarawak.

    PubMed

    Chen, P C; Tan, Y K

    1982-03-01

    A joint pilot project between the Ministry of Health and the Dept. of Social and Preventive Medicine, University of Malaya, to test the value of village aides in extending the health care system into isolated Iban communities was begun in May 1979 in the Entabai District of Sarawak. A group of 15 village aides consisting of 11 traditional Iban manangs (medicine men) and 4 youths were trained to provide primary health care including simple curative care, preventive care, and to assist in the detection of malaria. Evaluation carreid out 2 years later showed the following. With regard to curative care, the village aides were each, on the average, treating 70.6 patients/month, the most common complaint being headache (30.4%), which along with abdominal pain, constipation, bodyache, diarrhea, vomiting, fever, worm infections, cough, and sore throat, accounted for 89% of all illnesses seen by them. Subsequent to the introduction of village aides in the project area, the number of seriously ill patients requiring admission to the rest beds of the klinik desa dropped by 43.8% and the number of emergency referrals to the backup divisional hospitals fell by 46.1% showing that patients were coming to the klink desa for treatment at an earlier stage. The 11 traditional Iban manangs, who had recently received training had, on their own accord, drastically reduced the use of traditional Iban modes of therapy in preference for modern medicine. During the 24 months immediately after the introduction of village aides into Entabai, 9 gravity feed water supply systems together with related health packages advocating general cleanliness, the use of latrines, and fences were affected, whereas only 6 such systems were installed in the previous 24 months, indicating that it is likely that the village aides were of some assistance in mobilizing the community with respect to self-help efforts. During the same period, the majority of longhouses in the area successfully established a number

  14. A primary health care project in Sarawak.

    PubMed

    Chen, P C; Tan, Y K

    1982-03-01

    A joint pilot project between the Ministry of Health and the Dept. of Social and Preventive Medicine, University of Malaya, to test the value of village aides in extending the health care system into isolated Iban communities was begun in May 1979 in the Entabai District of Sarawak. A group of 15 village aides consisting of 11 traditional Iban manangs (medicine men) and 4 youths were trained to provide primary health care including simple curative care, preventive care, and to assist in the detection of malaria. Evaluation carreid out 2 years later showed the following. With regard to curative care, the village aides were each, on the average, treating 70.6 patients/month, the most common complaint being headache (30.4%), which along with abdominal pain, constipation, bodyache, diarrhea, vomiting, fever, worm infections, cough, and sore throat, accounted for 89% of all illnesses seen by them. Subsequent to the introduction of village aides in the project area, the number of seriously ill patients requiring admission to the rest beds of the klinik desa dropped by 43.8% and the number of emergency referrals to the backup divisional hospitals fell by 46.1% showing that patients were coming to the klink desa for treatment at an earlier stage. The 11 traditional Iban manangs, who had recently received training had, on their own accord, drastically reduced the use of traditional Iban modes of therapy in preference for modern medicine. During the 24 months immediately after the introduction of village aides into Entabai, 9 gravity feed water supply systems together with related health packages advocating general cleanliness, the use of latrines, and fences were affected, whereas only 6 such systems were installed in the previous 24 months, indicating that it is likely that the village aides were of some assistance in mobilizing the community with respect to self-help efforts. During the same period, the majority of longhouses in the area successfully established a number

  15. Pioneering community-oriented primary care.

    PubMed

    Susser, M

    1999-01-01

    This is a retrospective report on the importance of Kark and Cassel's 1952 paper on community-oriented primary care (COPC). In 1978, WHO and UNICEF endorsed COPC. However, the ideas girding and framing this approach had first been given full expression in practice some four decades earlier. In Depression-Era South Africa, Sidney Kark, a leader of the National Department of Health, converted the emergent discipline of social medicine into a unique form of comprehensive practice and established the Pholela Health Center, which was the explicit model for COPC. COPC as founded and practiced by Kark was a community, family and personal practice; it also was a multidisciplinary and team practice. Furthermore, the innovations of COPC entailed monitoring, evaluation, and research. Evaluation is the essence of Kark and Kassel's paper, which offers a convincing demonstration of the effects of COPC. Its key findings include the following: 1) that there was a decline in the incidence of syphilis in the area served by the health center; 2) that diet and nutrition improved; and 3) that the crude mortality rate as well as the infant mortality rate--the standard marker--declined in Pholela. In the succeeding decades, OPC had an international legacy (through WHO and H. Jack Geiger's influence in the US Office of Economic Opportunity), which came full circle in the 1980s, when a young generation of South Africans began to search their history for models for their health care programs at the dawn of the post-Apartheid Era.

  16. Primary care medicine in crisis: toward reconstruction and renewal.

    PubMed

    Moore, Gordon; Showstack, Jonathan

    2003-02-01

    Primary care is in crisis. Despite its proud history and theoretical advantages, the field has failed to hold its own among medical specialties. While the rest of medicine promises technology and sophistication, the basic model of primary care has changed little over the past half-century. Why has the transition from general practice to today's primary care been so difficult? Many of the causes of this struggle may lie within primary care itself, ranging from failure to articulate to the public (and insurers and policymakers) what value it, and it alone, can offer, to taking on an ever-broadening set of roles and responsibilities while all too often falling short of its promises. Perhaps most important, in the emerging health care system, the lack of a discrete definition of primary care has allowed managed care organizations and payers, among others, to define the role of primary care to suit their own interests. In response to a changing marketplace, political uncertainty, and shifting consumer expectations, primary care will need to reconstruct itself. The reconstruction will not be easy. Nevertheless, a process should begin that moves the field in the right direction. Building on its unique abilities, primary care can emerge as a redefined product that is attractive to patients, payers, and primary care practitioners alike. PMID:12558374

  17. 42 CFR 438.804 - Primary care provider payment increases.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Primary care provider payment increases. 438.804... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Conditions for Federal Financial Participation § 438.804 Primary care provider payment increases. (a) For MCO, PIHP or PAHP contracts that...

  18. Community participation in primary health care.

    PubMed

    MacCormack, C P

    1983-04-01

    The advantages of a community participation approach in primary health care (PHC) are as follows: a community participation approach is a cost effective way to extend a health care system to the geographical and social periphery of a country; communities that begin to understand their health status objectively rather than fatalistically may be moved to take a series of preventive measures; communities that invest labor, time, money, and materials in health promoting activities are more committed to the use and maintenance of the things they produce, such as water supplies; health education is most effective in the context of village activities; and community health workers, if they are well chosen, have the confidence of the people. An error made in early efforts at community participation was to assume that villages were uniformly free from internal exploitation. Some are cohesive moral communities, but in other there is grievous exploitation of landless laborers by landowners and shopkeepers. Villages may be divided by caste or ethnic origin. Political organization of villages may be democratic or they may be governed in an authoritarian manner. In politically unstable countries where the central government has a rather tenuous control over the rural periphery, genuine community initiatives may be viewed as threatening and may not receive official encouragement. Social groups within communities may be tremendous assets. In planning the community participation aspects of primary health care, the collaboration of an anthropologist or rural sociologist with field experience is recommended. Promoting community participation is a skill which must be taught to community health workers, and backed up with support services. The genuine commitment of medical staff to community self help is crucial to the motivation process. Motivation within the community quickly breaks down if materials, expertise, and salaries fail to arrive when promised. Community activities are most

  19. Time pressured deprioritization of COPD in primary care: a qualitative study

    PubMed Central

    Sandelowsky, Hanna; Hylander, Ingrid; Krakau, Ingvar; Modin, Sonja; Ställberg, Björn; Nager, Anna

    2016-01-01

    Objective To identify factors that hinder discussions regarding chronic obstructive pulmonary disease (COPD) between primary care physicians (PCPs) and their patients in Sweden. Setting Primary health care centres (PHCCs) in Stockholm, Sweden. Subjects A total of 59 PCPs. Design Semi-structured individual and focus-group interviews between 2012 and 2014. Data were analysed inspired by grounded theory methods (GTM). Results Time-pressured patient–doctor consultations lead to deprioritization of COPD. During unscheduled visits, deprioritization resulted from focusing only on acute health concerns, while during routine care visits, COPD was deprioritized in multi-morbid patients. The reasons PCPs gave for deprioritizing COPD are: “Not becoming aware of COPD”, “Not becoming concerned due to clinical features”, “Insufficient local routines for COPD care”, “Negative personal attitudes and views about COPD”, “Managing diagnoses one at a time”, and “Perceiving a patient’s motivation as low’’. Conclusions De-prioritization of COPD was discovered during PCP consultations and several factors were identified associated with time constraints and multi-morbidity. A holistic consultation approach is suggested, plus extended consultation time for multi-morbid patients, and better documentation and local routines. Key pointsUnder-diagnosis and insufficient management of chronic obstructive pulmonary disease (COPD) are common in primary health care. A patient–doctor consultation offers a key opportunity to identify and provide COPD care. Time pressure, due to either high number of patients or multi-morbidity, leads to omission or deprioritization of COPD during consultation.Deprioritization occurs due to lack of awareness, concern, and local routines, negative personal views, non-holistic consultation approach, and low patient motivation.Better local routines, extended consultation time, and a holistic approach are needed when managing multi

  20. Leadership in primary health care: an international perspective.

    PubMed

    McMurray, Anne

    2007-08-01

    A primary health care approach is essential to contemporary nursing roles such as practice nursing. This paper examines the evolution of primary health care as a global strategy for responding to the social determinants of health. Primary health care roles require knowledge of, and a focus on social determinants of health, particularly the societal factors that allow and perpetuate inequities and disadvantage. They also require a depth and breadth of leadership skills that are responsive to health needs, appropriate in the social and regulatory context, and visionary in balancing both workforce and client needs. The key to succeeding in working with communities and groups under a primary health care umbrella is to balance the big picture of comprehensive primary health care with operational strategies for selective primary health care. The other essential element involves using leadership skills to promote inclusiveness, empowerment and health literacy, and ultimately, better health.

  1. Review of Integrated Psychological Services in Primary Care.

    PubMed

    Smith, Michele S

    2016-06-01

    Reviews the book, Integrated Psychological Services in Primary Care edited by William Scott Craig (see record 2016-01850-000). This book opens with an article by the editor, in which he outlines the behavioral health needs of primary care patients and the rationale behind integrating mental health services in primary care settings. Subsequent chapters address basic and practical information for a variety of practice locations, such as Patient Centered Medical Home clinics, the Veteran's Administration medical centers, and primary care settings where the concept of integrated health is new. This is an excellent primer for anyone planning to implement an integrated care program or for those considering moving from an independent practice, agency, or traditional health care/hospital environment into an integrated primary care environment. The authors' writing styles made difficult concepts easy to understand and their knowledge of the utility of integration was evident. (PsycINFO Database Record PMID:27270257

  2. Sample size calculations for intervention trials in primary care randomizing by primary care group: an empirical illustration from one proposed intervention trial.

    PubMed

    Eldridge, S; Cryer, C; Feder, G; Underwood, M

    2001-02-15

    Because of the central role of the general practice in the delivery of British primary care, intervention trials in primary care often use the practice as the unit of randomization. The creation of primary care groups (PCGs) in April 1999 changed the organization of primary care and the commissioning of secondary care services. PCGs will directly affect the organization and delivery of primary, secondary and social care services. The PCG therefore becomes an appropriate target for organizational and educational interventions. Trials testing these interventions should involve randomization by PCG. This paper discusses the sample size required for a trial in primary care assessing the effect of a falls prevention programme among older people. In this trial PCGs will be randomized. The sample size calculations involve estimating intra-PCG correlation in primary outcome: fractured femur rate for those 65 years and over. No data on fractured femur rate were available at PCG level. PCGs are, however, similar in size and often coterminous with local authorities. Therefore, intra-PCG correlation in fractured femur rate was estimated from the intra-local authority correlation calculated from routine data. Three alternative trial designs are considered. In the first design, PCGs are selected for inclusion in the trial from the total population of England (eight regions). In the second design, PCGs are selected from two regions only. The third design is similar to the second except that PCGs are stratified by region and baseline value of fracture rate. Intracluster correlation is estimated for each of these designs using two methods: an approximation which assumes cluster sizes are equal and an alternative method which takes account of the fact that cluster sizes vary. Estimates of sample size required vary between 26 and 7 PCGs in each intervention group, depending on the trial design and the method used to calculate sample size. Not unexpectedly, stratification by baseline

  3. Primary Care of the Solid Organ Transplant Recipient.

    PubMed

    Wong, Christopher J; Pagalilauan, Genevieve

    2015-09-01

    Solid organ transplantation (SOT) is one of the major advances in medicine. Care of the SOT recipient is complex and continued partnership with the transplant specialist is essential to manage and treat complications and maintain health. The increased longevity of SOT recipients will lead to their being an evolving part of primary care practice, with ever more opportunities for care, education, and research of this rewarding patient population. This review discusses the overall primary care management of adult SOT recipients.

  4. Leadership for primary health care research.

    PubMed

    Pendleton, David

    2012-10-01

    Over the last decade, I have put together a new theory of leadership. This paper describes its four propositions, which are consistent with the research literature but which lead to conclusions that are not commonly held and seldom put into practice. The first proposition is a model describing the territory of leadership that is different from either the Leadership Qualities Framework, 2006 or the Medical Leadership Competency Framework, 2010, both of which have been devised specifically for the NHS (National Health Service). The second proposition concerns the ill-advised attempt of individuals to become expert in all aspects of leadership: complete in themselves. The third suggests how personality and capability are related. The fourth embraces and recommends the notion of complementary differences among leaders. As the NHS seeks increasing leadership effectiveness, these propositions may need to be considered and their implications woven into the fabric of NHS leader selection and development. Primary Health Care research, like all fields of collective human endeavour, is eminently in need of sound leadership and the same principles that facilitate sound leadership in other fields is likely to be relevant to research teams.

  5. Resilience and depression: perspectives from primary care.

    PubMed

    Dowrick, Christopher; Kokanovic, Renata; Hegarty, Kelsey; Griffiths, Frances; Gunn, Jane

    2008-10-01

    Resilience refers to the capacity for successful adaptation or change in the face of adversity. This concept has rarely been applied to the study of distress and depression. We propose two key elements of resilience - ordinary magic and personal medicine - which enable people to survive and flourish despite current experience of emotional distress. We investigate the extent to which these elements are considered important by a sample of 100 people, drawn from a longitudinal study of the management of depression in primary care in Victoria, Australia. We also assess how respondents rate personal resilience in comparison with help received from professional sources. Our data are obtained from semi-structured telephone interviews, and analysed inductively through refinement of our theoretical framework. We find substantial evidence of resilience both in terms of ordinary magic - drawing on existing social support and affectional bonds; and in terms of personal medicine - building on personal strengths and expanding positive emotions. There is a strong preference for personal over professional approaches to dealing with mental health problems. We conclude that personal resilience is important in the minds of our respondents, and that these elements should be actively considered in future research involving people with experience of mental health problems.

  6. Treating Teen Depression in Primary Care.

    PubMed

    Santiago, Sabrina

    2015-11-01

    I recently had an adolescent patient who presented with a chief complaint of depression. He had classic symptoms of difficulty sleeping, dysthymia, and anhedonia (loss of interest in things that used to bring him joy). He was a very smart and self-aware 17-year-old, and was able to describe his symptoms easily. There were no concerns for manic episodes or psychosis, and he met diagnostic criteria for unipolar major depressive disorder. He denied suicidal ideation, and was already seeing a therapist weekly for the last several months. He had a strong family history of depression, with his father, aunts, and grandmother who also carried a diagnosis of depression. He presented with the support of his mother, asking about next steps, and specifically, pharmacotherapy. This patient is a perfect example of an adolescent who is a good candidate for initiation of antidepressant medication. Primary care pediatricians should feel comfortable with first-line agents for major depressive disorder in certain adolescents with depression, but many feel hesitant and rely on child and adolescent psychiatry colleagues for prescriptions. PMID:26587812

  7. [Burnout syndrome in primary health care professionals].

    PubMed

    Martins, Leonardo Fernandes; Laport, Tamires Jordão; Menezes, Vinicius de Paula; Medeiros, Priscila Bonfante; Ronzani, Telmo Mota

    2014-12-01

    Burnout is characterized by emotional exhaustion, depersonalization and low occupational performance, which may occur among health professionals. This article evaluates burnout among workers in Primary Health Care (PHC) in three small towns in the Zona da Mata Mineira. The study analyzes associations by logistic regression between burnout, socioeconomic, and demographic aspects of work. A total of 149 professionals were selected, 107 of these responded to all questionnaires. To measure burnout, the Maslach Burnout Inventory (MBI) was used and to characterize the professional, a questionnaire assessing three different issues - namely individual and sociodemographic aspects and team area coverage - was used. 101 professionals were classified with positive indication for burnout. The variables present in the backward stepwise logistic regression model positively associated with indicative of burnout were: being younger than the population average (> 29.5 years) and use of drugs, including sedatives, tranquilizers and sleeping pills. The results contribute to the identification of factors associated with burnout and therefore highlight the need for more detailed investigation. PMID:25388182

  8. [Relations with emergency medical care and primary care doctor, home health care].

    PubMed

    Azuma, Kazunari; Ohta, Shoichi

    2016-02-01

    Medical care for an ultra-aging society has been shifted from hospital-centered to local community-based. This shift has yielded the so-called Integrated Community Care System. In the system, emergency medical care is considered important, as primary care doctors and home health care providers play a crucial role in coordinating with the department of emergency medicine. Since the patients move depending on their physical condition, a hospital and a community should collaborate in providing a circulating service. The revision of the medical payment system in 2014 clearly states the importance of "functional differentiation and strengthen and coordination of medical institutions, improvement of home health care". As part of the revision, the subacute care unit has been integrated into the community care unit, which is expected to have more than one role in community coordination. The medical fee has been set for the purpose of promoting the home medical care visit, and enhancing the capability of family doctors. In the section of end-of-life care for the elderly, there have been many issues such as reduction of the readmission rate and endorsement of a patient's decision-making, and judgment for active emergency medical care for patient admission. The concept of frailty as an indicator of prognosis has been introduced, which might be applied to the future of emergency medicine. As described above, the importance of a primary doctor and a family doctor should be identified more in the future; thereby it becomes essential for doctors to closely work with the hospital. Advancing the cooperation between a hospital and a community for seamless patient-centered care, the emergency medicine as an integrated community care will further develop by adapting to an ultra-aging society. PMID:26915240

  9. Reciproc vs. hand instrumentation in dental practice: a study in routine care.

    PubMed

    Bartols, Andreas; Reutter, Claudius A; Robra, Bernt-Peter; Walther, Winfried

    2016-01-01

    Background. Little is known about the clinical impact of new root canal preparation systems in general dental practice under routine care conditions. Therefore, we compared hand instrumentation (H) with Reciproc (R) (VDW, Munich, Germany) preparation. The outcomes were endodontic related pain and oral health related quality of life (OHRQoL), evaluation of the procedures by the patients and the strain felt by the dentists during root canal therapy. Methods. Six dentists participated in the trial as practitioner-investigators. In the first phase of the trial they prepared root canals with H and in the second phase with R. The patients documented their pain felt with a visual analogue scale (VAS 100) and OHRQoL with the German short version of the oral health impact profile (OHIP-G-14) before treatment and before the completion of therapy and answered questions about how they experienced the treatment. The dentists documented their physical strain during treatment. Results. A total of 137 patients were included in the evaluation. 66 patients were treated with H, 71 with R. Pain reduction was 32.6 (SD 32.9) VAS (H) vs. 29.4 (SD 26.9) VAS (R) (p = 0.550), and the improvement of the OHIP-14 score was 5.5 (SD 9.2) (H) vs. 6.7 (SD 7.4) (R) (p = 0.383). There were no statistical differences in both groups. Significantly fewer patients felt stressed by the duration of treatment with R as with H (p = 0.018). Significantly more dentists reported that their general physical strain and the strain on their fingers were less severe with R than with H (p = 0.013 and p < 0.001). Discussion. H as well as R effectively reduced endodontic related pain and OHRQoL without statistical differences. R has advantages in terms of how patients experience the treatment and regarding the physical strain felt by the dentists. PMID:27375972

  10. Reciproc vs. hand instrumentation in dental practice: a study in routine care

    PubMed Central

    Reutter, Claudius A.; Robra, Bernt-Peter; Walther, Winfried

    2016-01-01

    Background. Little is known about the clinical impact of new root canal preparation systems in general dental practice under routine care conditions. Therefore, we compared hand instrumentation (H) with Reciproc (R) (VDW, Munich, Germany) preparation. The outcomes were endodontic related pain and oral health related quality of life (OHRQoL), evaluation of the procedures by the patients and the strain felt by the dentists during root canal therapy. Methods. Six dentists participated in the trial as practitioner–investigators. In the first phase of the trial they prepared root canals with H and in the second phase with R. The patients documented their pain felt with a visual analogue scale (VAS 100) and OHRQoL with the German short version of the oral health impact profile (OHIP-G-14) before treatment and before the completion of therapy and answered questions about how they experienced the treatment. The dentists documented their physical strain during treatment. Results. A total of 137 patients were included in the evaluation. 66 patients were treated with H, 71 with R. Pain reduction was 32.6 (SD 32.9) VAS (H) vs. 29.4 (SD 26.9) VAS (R) (p = 0.550), and the improvement of the OHIP-14 score was 5.5 (SD 9.2) (H) vs. 6.7 (SD 7.4) (R) (p = 0.383). There were no statistical differences in both groups. Significantly fewer patients felt stressed by the duration of treatment with R as with H (p = 0.018). Significantly more dentists reported that their general physical strain and the strain on their fingers were less severe with R than with H (p = 0.013 and p < 0.001). Discussion. H as well as R effectively reduced endodontic related pain and OHRQoL without statistical differences. R has advantages in terms of how patients experience the treatment and regarding the physical strain felt by the dentists. PMID:27375972

  11. Reciproc vs. hand instrumentation in dental practice: a study in routine care.

    PubMed

    Bartols, Andreas; Reutter, Claudius A; Robra, Bernt-Peter; Walther, Winfried

    2016-01-01

    Background. Little is known about the clinical impact of new root canal preparation systems in general dental practice under routine care conditions. Therefore, we compared hand instrumentation (H) with Reciproc (R) (VDW, Munich, Germany) preparation. The outcomes were endodontic related pain and oral health related quality of life (OHRQoL), evaluation of the procedures by the patients and the strain felt by the dentists during root canal therapy. Methods. Six dentists participated in the trial as practitioner-investigators. In the first phase of the trial they prepared root canals with H and in the second phase with R. The patients documented their pain felt with a visual analogue scale (VAS 100) and OHRQoL with the German short version of the oral health impact profile (OHIP-G-14) before treatment and before the completion of therapy and answered questions about how they experienced the treatment. The dentists documented their physical strain during treatment. Results. A total of 137 patients were included in the evaluation. 66 patients were treated with H, 71 with R. Pain reduction was 32.6 (SD 32.9) VAS (H) vs. 29.4 (SD 26.9) VAS (R) (p = 0.550), and the improvement of the OHIP-14 score was 5.5 (SD 9.2) (H) vs. 6.7 (SD 7.4) (R) (p = 0.383). There were no statistical differences in both groups. Significantly fewer patients felt stressed by the duration of treatment with R as with H (p = 0.018). Significantly more dentists reported that their general physical strain and the strain on their fingers were less severe with R than with H (p = 0.013 and p < 0.001). Discussion. H as well as R effectively reduced endodontic related pain and OHRQoL without statistical differences. R has advantages in terms of how patients experience the treatment and regarding the physical strain felt by the dentists.

  12. The 10 Building Blocks of High-Performing Primary Care

    PubMed Central

    Bodenheimer, Thomas; Ghorob, Amireh; Willard-Grace, Rachel; Grumbach, Kevin

    2014-01-01

    Our experiences studying exemplar primary care practices, and our work assisting other practices to become more patient centered, led to a formulation of the essential elements of primary care, which we call the 10 building blocks of high-performing primary care. The building blocks include 4 foundational elements—engaged leadership, data-driven improvement, empanelment, and team-based care—that assist the implementation of the other 6 building blocks—patient-team partnership, population management, continuity of care, prompt access to care, comprehensiveness and care coordination, and a template of the future. The building blocks, which represent a synthesis of the innovative thinking that is transforming primary care in the United States, are both a description of existing high-performing practices and a model for improvement. PMID:24615313

  13. The expanding role of primary care in cancer control.

    PubMed

    Rubin, Greg; Berendsen, Annette; Crawford, S Michael; Dommett, Rachel; Earle, Craig; Emery, Jon; Fahey, Tom; Grassi, Luigi; Grunfeld, Eva; Gupta, Sumit; Hamilton, Willie; Hiom, Sara; Hunter, David; Lyratzopoulos, Georgios; Macleod, Una; Mason, Robert; Mitchell, Geoffrey; Neal, Richard D; Peake, Michael; Roland, Martin; Seifert, Bohumil; Sisler, Jeff; Sussman, Jonathan; Taplin, Stephen; Vedsted, Peter; Voruganti, Teja; Walter, Fiona; Wardle, Jane; Watson, Eila; Weller, David; Wender, Richard; Whelan, Jeremy; Whitlock, James; Wilkinson, Clare; de Wit, Niek; Zimmermann, Camilla

    2015-09-01

    The nature of cancer control is changing, with an increasing emphasis, fuelled by public and political demand, on prevention, early diagnosis, and patient experience during and after treatment. At the same time, primary care is increasingly promoted, by governments and health funders worldwide, as the preferred setting for most health care for reasons of increasing need, to stabilise health-care costs, and to accommodate patient preference for care close to home. It is timely, then, to consider how this expanding role for primary care can work for cancer control, which has long been dominated by highly technical interventions centred on treatment, and in which the contribution of primary care has been largely perceived as marginal. In this Commission, expert opinion from primary care and public health professionals with academic and clinical cancer expertise—from epidemiologists, psychologists, policy makers, and cancer specialists—has contributed to a detailed consideration of the evidence for cancer control provided in primary care and community care settings. Ranging from primary prevention to end-of-life care, the scope for new models of care is explored, and the actions needed to effect change are outlined. The strengths of primary care—its continuous, coordinated, and comprehensive care for individuals and families—are particularly evident in prevention and diagnosis, in shared follow-up and survivorship care, and in end-of-life care. A strong theme of integration of care runs throughout, and its elements (clinical, vertical, and functional) and the tools needed for integrated working are described in detail. All of this change, as it evolves, will need to be underpinned by new research and by continuing and shared multiprofessional development.

  14. Integrated primary care in Germany: the road ahead

    PubMed Central

    Schlette, Sophia; Lisac, Melanie; Blum, Kerstin

    2009-01-01

    Problem statement Health care delivery in Germany is highly fragmented, resulting in poor vertical and horizontal integration and a system that is focused on curing acute illness or single diseases instead of managing patients with more complex or chronic conditions, or managing the health of determined populations. While it is now widely accepted that a strong primary care system can help improve coordination and responsiveness in health care, primary care has so far not played this role in the German system. Primary care physicians traditionally do not have a gatekeeper function; patients can freely choose and directly access both primary and secondary care providers, making coordination and cooperation within and across sectors difficult. Description of policy development Since 2000, driven by the political leadership and initiative of the Federal Ministry of Health, the German Bundestag has passed several laws enabling new forms of care aimed to improve care coordination and to strengthen primary care as a key function in the German health care system. These include on the contractual side integrated care contracts, and on the delivery side disease management programmes, medical care centres, gatekeeping and ‘community medicine nurses’. Conclusion and discussion Recent policy reforms improved framework conditions for new forms of care. There is a clear commitment by the government and the introduction of selective contracting and financial incentives for stronger cooperation constitute major drivers for change. First evaluations, especially of disease management programmes, indicate that the new forms of care improve coordination and outcomes. Yet the process of strengthening primary care as a lever for better care coordination has only just begun. Future reforms need to address other structural barriers for change such as fragmented funding streams, inadequate payment systems, the lack of standardized IT systems and trans-sectoral education and training of

  15. Primary Care, Ambulatory Care, and Family Medicine: Overlapping But Not Synonymous

    ERIC Educational Resources Information Center

    Reynolds, Robert E.

    1975-01-01

    Defines and depicts graphically the relationships between primary, secondary, and tertiary care functions (from least to most intensified phases of medical care); ambulatory care (care of sick or well people not confined to bed); and family medicine (an emerging medical discipline focusing on complete and longterm care of the family). (JT)

  16. SGA Children in Pediatric Primary Care

    PubMed Central

    Gallo, Patrizia; Cioffi, Luigi; Limauro, Raffaele; Farris, Evelina; Bianco, Vincenzo; Sassi, Roberto; De Giovanni, Maria; Gallo, Valeria; D’Onofrio, Antonietta; Di Maio, Salvatore

    2016-01-01

    Background: Epidemiologic evidences suggest a strong association between low birth weight and some diseases in adult life ( hypertension, diabetes, cardiovascular diseases).Aim of this study was to evaluate the obesity/overweight prevalence in a population of children born small for gestation age, SGA children 400, 208 males and 192 females compared to a population of children born appropriate for gestational age 6818 AGA children, 3502 males and 3316 females, during childhood. Our intention was also to build the natural history of weight gain during prepubertal age in children born SGA and AGA. Design and Methods: Observational prospective longitudinal study. We followed our patients from January2001 up to December 2010; weight, height and body mass index (BMI) were evaluated in all the SGA and AGA children. BMI z-score range for defining overweight and obesity was, respectively, 1.13 to 1.7 and >1.7 according to CDC growth charts. Results: In transversal evaluation, we prove that 10-year-old SGA females are twice obese and more overweight compared to equal age AGA females. In longitudinal evaluation, we highlight different observations: SGA children obese at 2 years are still obese at 10 years; the number of obese SGA children increases gradually until the age of 10; AGA children, appear to be less obese than SGA children at 10 years. Conclusion: SGA males and females are more obese at 5 and 10 years compared to the AGA population. Primary care pediatricians, through early detection of the children at risk, can carry out an effective obesity prevention project in SGA children. PMID:27583297

  17. Abbreviated Pandemic Influenza Planning Template for Primary Care Offices

    SciTech Connect

    HCTT CHE

    2010-01-01

    The Abbreviated Pandemic Influenza Plan Template for Primary Care Provider Offices is intended to assist primary care providers and office managers with preparing their offices for quickly putting a plan in place to handle an increase in patient calls and visits, whether during the 2009-2010 influenza season or future influenza seasons.

  18. In Defence of Care: Gilligan's Relevance for Primary Education

    ERIC Educational Resources Information Center

    Adams, Paul

    2015-01-01

    In the main, writing about care seems to contrast the ethics of justice with the ethics of care. Whilst the former deploys objectivity, the latter holds that individuals are connected. Problematically, contemporary primary education seemingly holds a-personal, justice conceptions as its basis and rationale. In turn, primary education, in parts,…

  19. College Students' Reasons for Depression Nondisclosure in Primary Care

    ERIC Educational Resources Information Center

    Meyer, William J.; Morrison, Patrick; Lombardero, Anayansi; Swingle, Kelsey; Campbell, Duncan G.

    2016-01-01

    Unwillingness to share depression experiences with primary care physicians contributes to the undertreatment of depression. This project examined college students' reasons for depression nondisclosure to primary care providers (PCPs). Undergraduate participants read a vignette describing someone with depression and completed measures of disclosure…

  20. International sources of learning for the organisation of primary care

    PubMed Central

    2012-01-01

    This article explores the potential to learn from emerging international models of primary care organisation. It examines a series of exemplars from Southern Europe and Latin America which may help support moves towards a ‘new localism’ in the public management of primary care. Six lessons for the UK are identified. PMID:26265949

  1. Primary Care in the Baccalaureate Nursing Program. Pathways to Practice.

    ERIC Educational Resources Information Center

    Haase, Patricia T.

    The work and findings of the Southern Regional Education Board's Nursing Curriculum Project (NCP) for baccalaureate programs, which included faculty development programs for primary nursing care and clinical electives, are discussed. The historical background of primary care in the baccalaureate nursing program is traced, and characteristics of…

  2. Dermatologic Practice: Implications for a Primary Care Residency Curriculum.

    ERIC Educational Resources Information Center

    Branch, William T., Jr.; And Others

    1983-01-01

    The problems encountered, diagnostic procedures performed, and treatments prescribed in dermatology were studied in a primary care practice and in a dermatology clinic. It is proposed that the findings of this study be the basis for designing a curriculum in dermatology for residents in primary care medicine. (Author/MLW)

  3. Primary Care of Adult Women: Common Dermatologic Conditions.

    PubMed

    Ruiz de Luzuriaga, Arlene M; Mhlaba, Julie; Roman, Carly

    2016-06-01

    Dermatologic disease often presents in the primary care setting. Therefore, it is important for the primary care provider to be familiar with the presentation, diagnosis, and treatment of common skin conditions. This article provides an overview of acne, rosacea, melasma, vitiligo, alopecia, nonmelanoma, and melanoma skin cancer, dermatitis, and lichen sclerosus. PMID:27212088

  4. Organizational effectiveness. Primary care and the congruence model.

    PubMed

    Eiser, A R; Eiser, B J

    1996-10-01

    The congruence model is a framework used to analyze organizational strengths and weaknesses and pinpoint specific areas for improving effectiveness. This article provides an overview of organizations as open systems, with examples in the primary care arena. It explains and applies the congruence model in the context of primary care issues and functions, including methods by which the model can be used to diagnose organizational problems and generate solutions. Changes needed in primary care due to the managed care environment, and areas of potential problems and sensitivities requiring organizational changes to meet market and regulatory demands now placed on PCOs are examined.

  5. Primary health care for Hispanic children of migrant farm workers.

    PubMed

    Wilson, A H; Wold, J L; Spencer, L; Pittman, K

    2000-01-01

    Providing primary care to children of culturally diverse populations is a challenge for pediatric nurse practitioners and educators. The challenge is intensified when providing care to Hispanic children who are uprooted because their parent(s) are migrant farm workers. The creation of health-focused academic community partnerships is one unique strategy to improve primary care to these children. One such partnership is the ongoing Migrant Family Health Program in which practitioner nursing students and their faculty members provide primary health care to children who are enrolled in a summer education program for migrant children. PMID:11005882

  6. Health area profiles as tools for primary care development: New York's primary care initiative.

    PubMed

    Tenan, P M

    1992-10-01

    It is anticipated that the ACS measures will figure significantly in the formal evaluation of the PCI, which will be carried out by an independent evaluator during the second and third years of the program. ACS measures will also form, along with other relevant data, a module for program reporting that is part of the overall program for project monitoring and review. The program should be evaluated on its ability to adhere to ACS measures; infuse primary care resources into a community; observe and measure changes in the community's patterns of use for health services; examine the community's health status, especially for hospitalization for otherwise preventable conditions; and sustain effective, adequate health care resources within the community. PMID:10122100

  7. Ethical matters in rural integrated primary care settings.

    PubMed

    Mullin, Daniel; Stenger, Joseph

    2013-03-01

    Integrated primary care is particularly valuable to rural communities. Behavioral health care is often in short supply, and small or close-knit communities can intensify the stigma of seeking specialty mental health in rural settings. These and other barriers result in reduced access to needed behavioral health care. Nonetheless, rural practice of integrated primary care presents unique challenges to practitioners of multiple disciplines, including issues of competence, confidentiality, and dual relationships. This article provides an illustrative vignette to describe ethical issues in the rural practice of integrated primary care. It will review discipline-specific guidance in approaching these challenges and will offer recommendations for addressing disparities in the approaches of various disciplines engaged in the practice of integrated primary care. PMID:23566130

  8. Electronic health record functionality needed to better support primary care.

    PubMed

    Krist, Alex H; Beasley, John W; Crosson, Jesse C; Kibbe, David C; Klinkman, Michael S; Lehmann, Christoph U; Fox, Chester H; Mitchell, Jason M; Mold, James W; Pace, Wilson D; Peterson, Kevin A; Phillips, Robert L; Post, Robert; Puro, Jon; Raddock, Michael; Simkus, Ray; Waldren, Steven E

    2014-01-01

    Electronic health records (EHRs) must support primary care clinicians and patients, yet many clinicians remain dissatisfied with their system. This article presents a consensus statement about gaps in current EHR functionality and needed enhancements to support primary care. The Institute of Medicine primary care attributes were used to define needs and meaningful use (MU) objectives to define EHR functionality. Current objectives remain focused on disease rather than the whole person, ignoring factors such as personal risks, behaviors, family structure, and occupational and environmental influences. Primary care needs EHRs to move beyond documentation to interpreting and tracking information over time, as well as patient-partnering activities, support for team-based care, population-management tools that deliver care, and reduced documentation burden. While stage 3 MU's focus on outcomes is laudable, enhanced functionality is still needed, including EHR modifications, expanded use of patient portals, seamless integration with external applications, and advancement of national infrastructure and policies. PMID:24431335

  9. Managing violence in primary care: an evidence-based approach.

    PubMed Central

    Wright, Nat M; Dixon, Cath A; Tompkins, Charlotte N

    2003-01-01

    An understanding of the risk factors for violence can help primary care staff to evaluate and manage risk in the primary care setting. They will be able to acknowledge that risk factors are not static but can vary according to time, place, situation, and support networks. General practitioners (GPs) should not ignore their clinical acumen, but should use their knowledge of the patient to form part of a risk assessment. Managing violence in primary care should focus on the individual; for example, in the training of primary care staff. It should also involve an examination of the wider structure of primary care; for example, the safe design of buildings, avoiding long waiting times, and having 'no intoxication' policies for practices. There is a pressing need for primary care-based research in this area. We acknowledge that in our understanding of this topic there are two extremes that should be avoided. The first is that our perceived risk of violence often exceeds the real, absolute risk. Where our perceptions are overstated, patients run the risk of being excluded from primary care or of being inappropriately detained on psychiatric wards under the Mental Health Act. At the other extreme, where risk is understated, staff can play the 'hero' or the 'martyr' in an attempt to defuse a situation without support from other colleagues. Like many other situations in primary care, working in isolation carries real and important risks. Threats of violence are best managed in primary care by having a collaborative practice approach underpinned by a support ethos from primary care organisations. PMID:14694671

  10. Routine PHQ-9 Depression Screening in Home Health Care: Depression Prevalence, Clinical and Treatment Characteristics and Screening Implementation

    PubMed Central

    Ell, Kathleen; Unützer, Jurgen; Aranda, Maria; Sanchez, Kathleen; Lee, Pey-Jiuan

    2006-01-01

    This study aimed to examine: the prevalence and correlates of depression among adults 65 and over on admission to diverse home health care programs; nurse compliance with routine screening using the PHQ-9; and concordance between the number of depressed individuals identified by the PHQ-9 and Medicare mandated nursing assessment following targeted nurse training in identifying depression among the elderly using a standard diagnostic screen. Data are drawn from routine screening of 9,178 patients (a 77% screening compliance rate). Of all patients screened, 782 (8.5%) met criteria for probable major depression and 148 (1.6%) for mild depression. Concordance between nurse identified depression via PHQ-9 vs OASIS depression assessment improved over that reported in previous studies. Findings suggest that the use of a routine screening tool for depression can be implemented with minimal in-house training and improves detection of depression among older adults with significant physical and functional impairment. PMID:16446263

  11. Using Quality Experts from Manufacturing to Transform Primary Care

    ERIC Educational Resources Information Center

    Steiner, Rose M.; Walsworth, David T.

    2010-01-01

    Introduction: Improving Performance in Practice (IPIP) is an initiative convened by the American Board of Medical Specialties. It investigates the efficacy of coaches in helping primary-care practices improve the care of patients with diabetes and asthma. Most IPIP states use coaches who have a health care background, and are trained in quality…

  12. The Impact of Continuous Care and Primary Caregivers.

    ERIC Educational Resources Information Center

    Lockwood, Rhodes

    2003-01-01

    The University of New Mexico Child Care Center implemented a program for the care of infants and toddlers characterized by continuous care by primary caregivers. In addition to expected beneficial consequences for children, the program also produced two unexpected outcomes. Families developed a sense of community and mutual support, and teacher…

  13. Racial Disparities In Geographic Access To Primary Care In Philadelphia.

    PubMed

    Brown, Elizabeth J; Polsky, Daniel; Barbu, Corentin M; Seymour, Jane W; Grande, David

    2016-08-01

    Primary care is often thought of as the gateway to improved health outcomes and can lead to more efficient use of health care resources. Because of primary care's cardinal importance, adequate access is an important health policy priority. In densely populated urban areas, spatial access to primary care providers across neighborhoods is poorly understood. We examined spatial variation in primary care access in Philadelphia, Pennsylvania. We calculated ratios of adults per primary care provider for each census tract and included buffer zones based on prespecified drive times around each tract. We found that the average ratio was 1,073; the supply of primary care providers varied widely across census tracts, ranging from 105 to 10,321. We identified six areas of Philadelphia that have much lower spatial accessibility to primary care relative to the rest of the city. After adjustment for sociodemographic and insurance characteristics, the odds of being in a low-access area were twenty-eight times greater for census tracts with a high proportion of African Americans than in tracts with a low proportion of African Americans. PMID:27503960

  14. Primary care at Swiss universities - current state and perspective

    PubMed Central

    2014-01-01

    Background There is increasing evidence that a strong primary care is a cornerstone of an efficient health care system. But Switzerland is facing a shortage of primary care physicians (PCPs). This pushed the Federal Council of Switzerland to introduce a multifaceted political programme to strengthen the position of primary care, including its academic role. The aim of this paper is to provide a comprehensive overview of the situation of academic primary care at the five Swiss universities by the end of year 2012. Results Although primary care teaching activities have a long tradition at the five Swiss universities with activities starting in the beginning of the 1980ies; the academic institutes of primary care were only established in recent years (2005 – 2009). Only one of them has an established chair. Human and financial resources vary substantially. At all universities a broad variety of courses and lectures are offered, including teaching in private primary care practices with 1331 PCPs involved. Regarding research, differences among the institutes are tremendous, mainly caused by entirely different human resources and skills. Conclusion So far, the activities of the existing institutes at the Swiss Universities are mainly focused on teaching. However, for a complete academic institutionalization as well as an increased acceptance and attractiveness, more research activities are needed. In addition to an adequate basic funding of research positions, competitive research grants have to be created to establish a specialty-specific research culture. PMID:24885148

  15. [Differences and similarities of primary care in the German and Spanish health care systems].

    PubMed

    Salvador Comino, María Rosa; Krane, Sibylla; Schelling, Jörg; Regife García, Víctor

    2016-02-01

    An efficient primary care is of particular importance for any countries' health care system. Many differences exist on how distinctive countries try to obtain the goal of an efficient, cost-effective primary care for its population. In this article we conducted a selective literature review, which includes both scientific and socio-political publications. The findings are complemented with the experience of a Spanish physician from Seville in her last year of training in family medicine, who completed a four months long rotation in the German health care system. We highlighted different features by comparing both countries, including their health care expenditure, the relation between primary and secondary care, the organization in the academic field and the training of future primary care physicians. It is clear that primary care in both countries plays a central role, have to deal with shortcomings, and in some points one system can learn from the other. PMID:26363955

  16. [Differences and similarities of primary care in the German and Spanish health care systems].

    PubMed

    Salvador Comino, María Rosa; Krane, Sibylla; Schelling, Jörg; Regife García, Víctor

    2016-02-01

    An efficient primary care is of particular importance for any countries' health care system. Many differences exist on how distinctive countries try to obtain the goal of an efficient, cost-effective primary care for its population. In this article we conducted a selective literature review, which includes both scientific and socio-political publications. The findings are complemented with the experience of a Spanish physician from Seville in her last year of training in family medicine, who completed a four months long rotation in the German health care system. We highlighted different features by comparing both countries, including their health care expenditure, the relation between primary and secondary care, the organization in the academic field and the training of future primary care physicians. It is clear that primary care in both countries plays a central role, have to deal with shortcomings, and in some points one system can learn from the other.

  17. The Value of Continuity between Primary Care and Surgical Care in Colon Cancer

    PubMed Central

    Hussain, Tanvir; Chang, Hsien-Yen; Luu, Ngoc-Phuong; Pollack, Craig Evan

    2016-01-01

    Background Improving continuity between primary care and cancer care is critical for improving cancer outcomes and curbing cancer costs. A dimension of continuity, we investigated how regularly patients receive their primary care and surgical care for colon cancer from the same hospital and whether this affects mortality and costs. Methods Using Surveillance, Epidemiology, and End Results Program Registry (SEER)-Medicare data, we performed a retrospective cohort study of stage I-III colon cancer patients diagnosed between 2000 and 2009. There were 23,305 stage I-III colon cancer patients who received primary care in the year prior to diagnosis and underwent operative care for colon cancer. Patients were assigned to the hospital where they had their surgery and to their primary care provider’s main hospital, and then classified according to whether these two hospitals were same or different. Outcomes examined were hazards for all-cause mortality, subhazard for colon cancer specific mortality, and generalized linear estimate for costs at 12 months, from propensity score matched models. Results Fifty-two percent of stage I-III colon patients received primary care and surgical care from the same hospital. Primary care and surgical care from the same hospital was not associated with reduced all-cause or colon cancer specific mortality, but was associated with lower inpatient, outpatient, and total costs of care. Total cost difference was $8,836 (95% CI $2,746–$14,577), a 20% reduction in total median cost of care at 12 months. Conclusions Receiving primary care and surgical care at the same hospital, compared to different hospitals, was associated with lower costs but still similar survival among stage I-III colon cancer patients. Nonetheless, health care policy which encourages further integration between primary care and cancer care in order to improve outcomes and decrease costs will need to address the significant proportion of patients receiving health care

  18. Cost-effectiveness of a Primary Care Depression Intervention

    PubMed Central

    Pyne, Jeffrey M; Rost, Kathryn M; Zhang, Mingliang; Williams, D Keith; Smith, Jeffrey; Fortney, John

    2003-01-01

    OBJECTIVE To determine the incremental cost-effectiveness of a quality improvement depression intervention (enhanced care) in primary care settings relative to usual care. DESIGN Following stratification, we randomized 12 primary care practices to enhanced or usual care conditions and followed patients for 12 months. SETTING Primary care practices located in 10 states across the United States. PATIENTS/PARTICIPANTS Two hundred eleven patients beginning a new treatment episode for major depression. INTERVENTIONS Training the primary care team to assess, educate, and monitor depressed patients during the acute and continuation stages of their depression treatment episode over 1 year. MEASUREMENTS AND MAIN RESULTS Cost-effectiveness was measured by calculating incremental (enhanced minus usual care) costs and quality-adjusted life years (QALYs) derived from SF-36 data. The mean incremental cost-effectiveness ratio in the main analysis was $15,463 per QALY. The mean incremental cost-effectiveness ratios for the sensitivity analyses ranged from $11,341 (using geographic block variables to control for pre-intervention service utilization) to $19,976 (increasing the cost estimates by 50%) per QALY. CONCLUSIONS This quality improvement depression intervention was cost-effective relative to usual care compared to cost-effectiveness ratios for common primary care interventions and commonly cited cost-effectiveness ratio thresholds for intervention implementation. PMID:12823650

  19. HIV and the primary care physician in Japan.

    PubMed

    Asai, A

    1997-01-01

    Primary care physicians in Japan must provide comprehensive medical care and counseling for persons both infected with and at risk for HIV/AIDS. Despite existing activities and education programs, HIV case numbers continue to rise in Japan, and only a limited number of hospitals and physicians offer care to those with HIV/AIDS. Some doctors in Japan refuse to accept patients with HIV/AIDS because of the complex treatment often involved, prejudice regarding AIDS, and fear of transmission. Other impediments to effective treatment of HIV/AIDS in Japan include insufficient risk evaluation through outpatient services, lack of privacy, and restrictions and policies at medical facilities. If Japan's primary care physicians cannot participate in caring for those with HIV/AIDS, it will be impossible for every patient with HIV/AIDS to receive correct and adequate medical care. To enable primary care physicians to provide high-quality service and prevention counseling to those with HIV/AIDS, prejudice, fear, and logistic impediments must be eradicated. Comprehensive practice guidelines that protect patients' rights and privacy should be established immediately. The guidelines should direct primary care physicians toward a logical and proper approach to HIV/AIDS care by addressing fundamental treatment and effective prevention counseling as well as the social problems surrounding HIV/AIDS. In addition, research on the general knowledge level and prevalent attitudes among Japan's primary care physicians regarding HIV/AIDS would clarify which specific issues the guidelines should emphasize.

  20. Considerations for a Primary Care Physician Assistant in Treating Kidney Transplant Recipients

    PubMed Central

    Aston, Ryan; Durkin, Allison; Harris, Kristen; Mace, Amanda; Moore, Sierra; Smith, Brittany; Soult, Eric; Wright, Mara; Yothers, Dustin; Latos, Derrick L.; Horzempa, Joseph

    2015-01-01

    The escalating amount of kidney transplant recipients (KTRs) represents a significant dilemma for primary care providers. As the number of physician assistants (PAs) has been steadily increasing in primary care in the United States, the utilization of these healthcare professionals presents a solution for the care of post-kidney transplant recipients. A physician assistant (PA) is a state licensed healthcare professional who practices medicine under physician supervision and can alleviate some of the increasing demands for primary patient care. Here we provide an outline of the crucial components and considerations for PAs caring for kidney transplant recipients. These include renal function and routine screenings, drug monitoring (both immunosuppressive and therapeutic), pre-existing and co-existing conditions, immunizations, nutrition, physical activity, infection, cancer, and the patient’s emotional well-being. PAs should routinely monitor renal function and blood chemistry of KTRs. Drug monitoring of KTRs is a crucial responsibility of the PA because of the possible side-effects and potential drug-drug interactions. Therefore, PAs should obtain a careful and detailed patient history from KTRs. PAs should be aware of pre- and co-existing conditions of KTRs as this impacts treatment decisions. Regarding immunization, PAs should avoid administering vaccines containing live or attenuated viruses to KTRs. Because obesity following kidney transplantation is associated with decreased allograft survival, PAs should encourage KTRs to maintain a balanced diet with limited sugar. In addition, KTRs should be urged to gradually increase their levels of physical activity over subsequent years following surgery. PAs should be aware that immunosuppressive medications diminish immune defenses and make KTRs more susceptible to bacterial, viral, and fungal infections. Moreover, KTRs should be screened routinely for cancer due to the higher risk of development from

  1. Collaborative care for depression in primary care: how psychiatry could "troubleshoot" current treatments and practices.

    PubMed

    Barkil-Oteo, Andres

    2013-06-01

    The bulk of mental health services for people with depression are provided in primary care settings. Primary care providers prescribe 79 percent of antidepressant medications and see 60 percent of people being treated for depression in the United States, and they do that with little support from specialist services. Depression is not effectively managed in the primary care setting. Collaborative care based on a team approach, a population health perspective, and measurement-based care has been proven to treat depression more effectively than care as usual in a variety of settings and for different populations, and it increases people's access to medications and behavioral therapies. Psychiatry has the responsibility of supporting the primary care sector in delivering mental health services by disseminating collaborative care approaches under recent initiatives and opportunities made possible by the Affordable Care Act (ACA).

  2. Predicting frequent COPD exacerbations using primary care data

    PubMed Central

    Kerkhof, Marjan; Freeman, Daryl; Jones, Rupert; Chisholm, Alison; Price, David B

    2015-01-01

    from routinely available, computerized primary care data. Further study is needed to validate the model in other patient populations. PMID:26609229

  3. Viscosupplementation for Osteoarthritis: a Primer for Primary Care Physicians

    PubMed Central

    2015-01-01

    Introduction Osteoarthritis (OA) constitutes a growing public health burden and the most common cause of disability in the United States. Non-pharmacologic modalities and conservative pharmacologic therapies are recommended for the initial treatment of OA, including acetaminophen, and topical and oral non-steroidal anti-inflammatory drugs. However, safety concerns continue to mount regarding the use of these treatments and none have been shown to impact disease progression. Viscosupplementation with injections of hyaluronans (HAs) are indicated when non-pharmacologic and simple analgesics have failed to relieve symptoms (e.g., pain, stiffness) associated with knee OA. This review evaluates literature focusing on the efficacy and/or safety of HA injections in treating OA of the knee and in other joints, including the hip, shoulder, and ankle. Methods Relevant literature on intra-articular (IA) HA injections as a treatment for OA pain in the knee and other joints was identified through PubMed database searches from inception until January 2013. Search terms included “hyaluronic acid” or “hylan”, and “osteoarthritis”. Discussion Current evidence indicates that HA injections are beneficial and safe for patients with OA of the knee. IA injections of HAs treat the symptoms of knee OA and may also have disease-modifying properties, potentially delaying progression of OA. Although traditionally reserved for second-line treatment, evidence suggests that HAs may have value as a first-line therapy in the treatment of knee OA as they have been shown to be more effective in earlier stages and grades of disease, more recently diagnosed OA, and in less severe radiographic OA. Conclusion For primary care physicians who treat and care for patients with OA of the knee, IA injection with HAs constitutes a safe and effective treatment that can be routinely administered in the office setting. PMID:24203348

  4. Maintaining standards of primary care in America

    PubMed Central

    Snider, K. A.

    1979-01-01

    The evolution of present day attitudes toward maintaining standards of medical care in the United States is described, and the main methods identified. Their influence on current practice is discussed, and application made to the promotion of high standards of care in British general practice. PMID:317108

  5. Refugee health: a new model for delivering primary health care.

    PubMed

    Kay, Margaret; Jackson, Claire; Nicholson, Caroline

    2010-01-01

    Providing health care to newly arrived refugees within the primary health care system has proved challenging. The primary health care sector needs enhanced capacity to provide quality health care for this population. The Primary Care Amplification Model has demonstrated its capacity to deliver effective health care to patients with chronic disease such as diabetes. This paper describes the adaption ofthe model to enhance the delivery ofhealth care to the refugee community. A 'beacon' practice with an expanded clinical capacity to deliver health care for refugees has been established. Partnerships link this practice with existing local general practices and community services. Governance involves collaboration between clinical leadership and relevant government and non-government organisations including local refugee communities. Integration with tertiary and community health sectors is facilitated and continuing education of health care providers is an important focus. Early incorporation of research in this model ensures effective feedback to inform providers of current health needs. Although implementation is currently in its formative phase, the Primary Care Amplification Model offers a flexible, yet robust framework to facilitate the delivery of quality health care to refugee patients.

  6. Holistic wound assessment in primary care.

    PubMed

    Cornforth, Amber

    2013-12-01

    Wound care is expensive and can cause immeasurable stress and inconvenience to patients and their significant others. It is therefore in the best interest of the patient, their significant others and the NHS as a whole that wounds are expertly assessed, managed and healed in the quickest timeframe possible. Nurses play a pivotal role in the process of accurate holistic wound assessment, evaluation and treatment. This article aims to help further develop and enhance both professional and clinical wound care assessment and evaluation skills. Pertinent wound care literature is critically reviewed and the crucial nature and important components of comprehensive wound assessment for facilitating the highest possible quality wound care to patients are presented alongside recommendations regarding how the enhanced knowledge and skills could be applied into everyday wound care practice.

  7. Management of alcoholism in the primary care setting.

    PubMed Central

    Bradley, K. A.

    1992-01-01

    Primary care physicians can play an important role in managing alcoholic patients. Identifying and treating alcoholism early, before it has interfered with patients' relationships and work, may increase the likelihood of prolonged recovery. Simple office interventions can help motivate patients to abstain and seek treatment. People who abuse alcohol and are unwilling to abstain can benefit from a recommendation to reduce their intake of alcohol. For alcohol-dependent patients who decide to stop drinking, primary care physicians often can manage withdrawal on an outpatient basis. Selecting an appropriate treatment program for each alcoholic patient is important, and referral to a specialist to assist in matching patients to treatments is often necessary. Primary care physicians also can help prevent relapse. Although disulfiram is of limited value, primary care physicians can support recovery by identifying coexistent psychosocial problems, helping patients to restructure their lives, and ensuring continuity of care. PMID:1595243

  8. THE CONTRIBUTIONS OF PHYSICIAN ASSISTANTS IN PRIMARY CARE SYSTEMS

    PubMed Central

    Hooker, Roderick S.; Everett, Christine M.

    2013-01-01

    Shortages of primary care doctors are occurring globally; one means of meeting this demand has been the use of physician assistants (PAs). Introduced in the United States in the late 1960s to address doctor shortages, the PA movement has grown to over 75,000 providers in 2011 and spread to Australia, Canada, Great Britain, The Netherlands, Germany, Ghana, and South Africa. A purposeful literature review was undertaken to assess the contribution of PAs to primary care systems. Contemporary studies suggest that PAs can contribute to the successful attainment of primary care functions, particularly the provision of comprehensive care, accessibility, and accountability. Employing PAs seems a reasonable strategy for providing primary care for diverse populations. PMID:21851446

  9. Applying the guidelines for pharmacists integrating into primary care teams

    PubMed Central

    Barry, Arden R.; Pammett, Robert T.

    2016-01-01

    Background: In 2013, Jorgenson et al. published guidelines for pharmacists integrating into primary care teams. These guidelines outlined 10 evidence-based recommendations designed to support pharmacists in successfully establishing practices in primary care environments. The aim of this review is to provide a detailed, practical approach to implementing these recommendations in real life, thereby aiding to validate their effectiveness. Methods: Both authors reviewed the guidelines independently and ranked the importance of each recommendation respective to their practice. Each author then provided feedback for each recommendation regarding the successes and challenges they encountered through implementation. This feedback was then consolidated into agreed upon statements for each recommendation. Results and Discussion: Focusing on building relationships (with an emphasis on face time) and demonstrating value to both primary care providers and patients were identified as key aspects in developing these new roles. Ensuring that the environment supports the practice, along with strategic positioning within the clinic, improves uptake and can maximize the usefulness of a pharmacist in primary care. Demonstrating consistent and competent clinical and documentation skills builds on the foundation of the other recommendations to allow for the effective provision of clinical pharmacy services. Additional recommendations include developing efficient ways (potentially provider specific) to communicate with primary care providers and addressing potential preconceived notions about the role of the pharmacist in primary care. Conclusion: We believe these guidelines hold up to real-life integration and emphatically recommend their use for new and existing primary care pharmacists. PMID:27540404

  10. Effect of Organizational Culture on Patient Access, Care Continuity, and Experience of Primary Care.

    PubMed

    Hung, Dorothy; Chung, Sukyung; Martinez, Meghan; Tai-Seale, Ming

    2016-01-01

    This study examined relationships between organizational culture and patient-centered outcomes in primary care. Generalized least squares regression was used to analyze patient access, care continuity, and reported experiences of care among 357 physicians in 41 primary care departments. Compared with a "Group-oriented" culture, a "Rational" culture type was associated with longer appointment wait times, and both "Hierarchical" and "Developmental" culture types were associated with less care continuity, but better patient experiences with care. Understanding the unique effects of organizational culture can enhance the delivery of more patient-centered care.

  11. Effect of Organizational Culture on Patient Access, Care Continuity, and Experience of Primary Care.

    PubMed

    Hung, Dorothy; Chung, Sukyung; Martinez, Meghan; Tai-Seale, Ming

    2016-01-01

    This study examined relationships between organizational culture and patient-centered outcomes in primary care. Generalized least squares regression was used to analyze patient access, care continuity, and reported experiences of care among 357 physicians in 41 primary care departments. Compared with a "Group-oriented" culture, a "Rational" culture type was associated with longer appointment wait times, and both "Hierarchical" and "Developmental" culture types were associated with less care continuity, but better patient experiences with care. Understanding the unique effects of organizational culture can enhance the delivery of more patient-centered care. PMID:27232685

  12. Chronic disease management: the primary care perspective.

    PubMed

    Bragaglia, Pauline; O'Brien, Lewis

    2007-01-01

    This response to the essay is a "view from the trenches" by two doctors who have worked over 23 years at the Group Health Centre in Sault Ste. Marie, Ontario. We would agree wholeheartedly that reducing wait times for selected procedures will not transform our health system, although they are a start that does provide improved quality of life for a relatively small number of people. We have struggled with the care gap between known best practices and the reality of care provided, from the perspectives of both prevention and chronic disease management. This has resulted in an acute awareness of the need for an across-the-system, "bottom-up" approach to the prevention of disease and management of healthcare. Limited resources must be carefully leveraged in innovative ways if we are to eliminate this care gap, decrease morbidity and minimize expensive "rescue" procedures that make our system increasingly unaffordable.

  13. Headache in primary care: how important is diagnosis to management?

    PubMed Central

    O'Flynn, Norma; Ridsdale, Leone

    2002-01-01

    Headache is a common presentation in primary care. The classification of headache was overhauled by the International Headache Society (IHS) in 1988, and the past decade has seen rapid growth in the understanding of headache disorders. The IHS places particular importance on precise headache diagnosis. This paper discusses the relevance of such an approach to primary care. A review of the literature revealed a dearth of evidence regarding headache management in primary care settings. The evidence from other settings is considered and gaps in the literature highlighted. PMID:12120731

  14. Pediatric psychopharmacology in primary care: a conceptual framework.

    PubMed

    Riddle, Mark A; dosReis, Susan; Reeves, Gloria M; Wissow, Lawrence S; Pruitt, David B; Foy, Jane Meschan

    2013-08-01

    In a 2009 policy statement focused on children's mental health, the American Academy of Pediatrics recommended that pediatric primary care physicians achieve competence in initiating care for children with attention-deficit/hyperactivity disorder (ADHD), anxiety, depression, and substance use/abuse. Because treatment for 3 of these conditions--ADHD, anxiety, and depression--may, under certain conditions, include medication, the primary purpose of this article is to offer guidance to assist primary care physicians in decision-making about their use of psychotropic medications for these conditions. A few medications with proven efficacy and safety are emphasized. Secondarily, other medications that may be useful for other disorders are noted.

  15. What Can Primary Care Learn From Sports Teams?

    PubMed

    Fiscella, Kevin; Fogarty, Colleen; Salas, Eduardo

    2016-01-01

    Teams are familiar to sports but relatively new to primary care. In this perspective, we use sports teams to illustrate key principles from team science and extract practical lessons for primary care teams. The most notable lessons include the need for continuous team learning based on presession planning and postsession debriefing, real-world team training focused on identified teamwork needs, and on-site team coaching. Implementation of these principles requires organizational commitment coupled with alignment of continuing medical education and recertification requirements with primary care teamwork competencies. PMID:27232689

  16. New Pathways for Primary Care: An Update on Primary Care Programs From the Innovation Center at CMS

    PubMed Central

    Baron, Richard J.

    2012-01-01

    Those in practice find that the fee-for-service system does not adequately value the contributions made by primary care. The Center for Medicare and Medicaid Innovation (Innovation Center) was created by the Affordable Care Act to test new models of health care delivery to improve the quality of care while lowering costs. All programs coming out of the Innovation Center are tests of new payment and service delivery models. By changing both payment and delivery models and moving to a payment model that rewards physicians for quality of care instead of volume of care, we may be able to achieve the kind of health care patients want to receive and primary care physicians want to provide. PMID:22412007

  17. Clinical Decision Making and Outcome in Routine Care for People with Severe Mental Illness (CEDAR): Study protocol

    PubMed Central

    2010-01-01

    Background A considerable amount of research has been conducted on clinical decision making (CDM) in short-term physical conditions. However, there is a lack of knowledge on CDM and its outcome in long-term illnesses, especially in care for people with severe mental illness. Methods/Design The study entitled "Clinical decision making and outcome in routine care for people with severe mental illness" (CEDAR) is carried out in six European countries (Denmark, Germany, Hungary, Italy, Switzerland and UK). First, CEDAR establishes a methodology to assess CDM in people with severe mental illness. Specific instruments are developed (and psychometric properties established) to measure CDM style, key elements of CDM in routine care, as well as CDM involvement and satisfaction from patient and therapist perspectives. Second, these instruments are being put to use in a multi-national prospective observational study (bimonthly assessments during a one-year observation period; N = 560). This study investigates the immediate, short- and long-term effect of CDM on crucial dimensions of clinical outcome (symptom level, quality of life, needs) by taking into account significant variables moderating the relationship between CDM and outcome. Discussion The results of this study will make possible to delineate quality indicators of CDM, as well as to specify prime areas for further improvement. Ingredients of best practice in CDM in the routine care for people with severe mental illness will be extracted and recommendations formulated. With its explicit focus on the patient role in CDM, CEDAR will also contribute to strengthening the service user perspective. This project will substantially add to improving the practice of CDM in mental health care across Europe. Trial register ISRCTN75841675. PMID:21062508

  18. The Australian experiment: how primary health care organizations supported the evolution of a primary health care system.

    PubMed

    Nicholson, Caroline; Jackson, Claire L; Marley, John E; Wells, Robert

    2012-03-01

    Primary health care in Australia has undergone 2 decades of change. Starting with a vision for a national health strategy with general practice at its core, Australia established local meso-level primary health care organizations--Divisions of General Practice--moving from focus on individual practitioners to a professional collective local voice. The article identifies how these meso-level organizations have helped the Australian primary health care system evolve by supporting the roll-out of initiatives including national practice accreditation, a focus on quality improvement, expansion of multidisciplinary teams into general practice, regional integration, information technology adoption, and improved access to care. Nevertheless, there are still challenges to ensuring equitable access and the supply and distribution of a primary care workforce, addressing the increasing rates of chronic disease and obesity, and overcoming the fragmentation of funding and accountability in the Australian system.

  19. A research agenda on patient safety in primary care. Recommendations by the LINNEAUS collaboration on patient safety in primary care

    PubMed Central

    Verstappen, Wim; Gaal, Sander; Bowie, Paul; Parker, Diane; Lainer, Miriam; Valderas, Jose M.; Wensing, Michel; Esmail, Aneez

    2015-01-01

    ABSTRACT Background: Healthcare can cause avoidable serious harm to patients. Primary care is not an exception, and the relative lack of research in this area lends urgency to a better understanding of patient safety, the future research agenda and the development of primary care oriented safety programmes. Objective: To outline a research agenda for patient safety improvement in primary care in Europe and beyond. Methods: The LINNEAUS collaboration partners analysed existing research on epidemiology and classification of errors, diagnostic and medication errors, safety culture, and learning for and improving patient safety. We discussed ideas for future research in several meetings, workshops and congresses with LINNEAUS collaboration partners, practising GPs, researchers in this field, and policy makers. Results: This paper summarizes and integrates the outcomes of the LINNEAUS collaboration on patient safety in primary care. It proposes a research agenda on improvement strategies for patient safety in primary care. In addition, it provides background information to help to connect research in this field with practicing GPs and other healthcare workers in primary care. Conclusion: Future research studies should target specific primary care domains, using prospective methods and innovative methods such as patient involvement. PMID:26339841

  20. Primary Care Practice Development: A Relationship-Centered Approach

    PubMed Central

    Miller, William L.; Crabtree, Benjamin F.; Nutting, Paul A.; Stange, Kurt C.; Jaén, Carlos Roberto

    2010-01-01

    PURPOSE Numerous primary care practice development efforts, many related to the patient-centered medical home (PCMH), are emerging across the United States with few guides available to inform them. This article presents a relationship-centered practice development approach to understand practice and to aid in fostering practice development to advance key attributes of primary care that include access to first-contact care, comprehensive care, coordination of care, and a personal relationship over time. METHODS Informed by complexity theory and relational theories of organizational learning, we built on discoveries from the American Academy of Family Physicians’ National Demonstration Project (NDP) and 15 years of research to understand and improve primary care practice. RESULTS Primary care practices can fruitfully be understood as complex adaptive systems consisting of a core (a practice’s key resources, organizational structure, and functional processes), adaptive reserve (practice features that enhance resilience, such as relationships), and attentiveness to the local environment. The effectiveness of these attributes represents the practice’s internal capability. With adequate motivation, healthy, thriving practices advance along a pathway of slow, continuous developmental change with occasional rapid periods of transformation as they evolve better fits with their environment. Practice development is enhanced through systematically using strategies that involve setting direction and boundaries, implementing sensing systems, focusing on creative tensions, and fostering learning conversations. CONCLUSIONS Successful practice development begins with changes that strengthen practices’ core, build adaptive reserve, and expand attentiveness to the local environment. Development progresses toward transformation through enhancing primary care attributes. PMID:20530396

  1. Improving delivery of primary care for vulnerable migrants

    PubMed Central

    Pottie, Kevin; Batista, Ricardo; Mayhew, Maureen; Mota, Lorena; Grant, Karen

    2014-01-01

    Abstract Objective To identify and prioritize innovative strategies to address the health concerns of vulnerable migrant populations. Design Modified Delphi consensus process. Setting Canada. Participants Forty-one primary care practitioners, including family physicians and nurse practitioners, who provided care for migrant populations. Methods We used a modified Delphi consensus process to identify and prioritize innovative strategies that could potentially improve the delivery of primary health care for vulnerable migrants. Forty-one primary care practitioners from various centres across Canada who cared for migrant populations proposed strategies and participated in the consensus process. Main findings The response rate was 93% for the first round. The 3 most highly ranked practice strategies to address delivery challenges for migrants were language interpretation, comprehensive interdisciplinary care, and evidence-based guidelines. Training and mentorship for practitioners, intersectoral collaboration, and immigrant community engagement ranked fourth, fifth, and sixth, respectively, as strategies to address delivery challenges. These strategies aligned with strategies coming out of the United States, Europe, and Australia, with the exception of the proposed evidence-based guidelines. Conclusion Primary health care practices across Canada now need to evolve to address the challenges inherent in caring for vulnerable migrants. The selected strategies provide guidance for practices and health systems interested in improving health care delivery for migrant populations. PMID:24452576

  2. Interprofessional education: preparing psychologists for success in integrated primary care.

    PubMed

    Cubic, Barbara; Mance, Janette; Turgesen, Jeri N; Lamanna, Jennifer D

    2012-03-01

    Rapidly occurring changes in the healthcare arena mean time is of the essence for psychology to formalize a strategic plan for training in primary care settings. The current article articulates factors affecting models of integrated care in Academic Health Centers (AHCs) and describes ways to identify and utilize resources at AHCs to develop interprofessional educational and clinical integrated care opportunities. The paper asserts that interprofessional educational experiences between psychology and other healthcare providers are vital to insure professionals value one another's disciplines in health care reform endeavors, most notably the patient-centered initiatives. The paper highlights ways to create shared values and common goals between primary care providers and psychologists, which are needed for trainee internalization of integrated care precepts. A developmental perspective to training from pre-doctoral, internship and postdoctoral levels for psychologists in integrated care is described. Lastly, a call to action is given for the field to develop more opportunities for psychology trainees to receive education and training within practica, internships and postdoctoral fellowships in primary care settings to address the reality that most patients seek their mental health treatment in primary care settings.

  3. Integrated working between residential care homes and primary care: a survey of care homes in England

    PubMed Central

    2012-01-01

    Background Older people living in care homes in England have complex health needs due to a range of medical conditions, mental health needs and frailty. Despite an increasing policy expectation that professionals should operate in an integrated way across organisational boundaries, there is a lack of understanding between care homes and the National Health Service (NHS) about how the two sectors should work together, meaning that residents can experience a poor "fit" between their needs, and services they can access. This paper describes a survey to establish the current extent of integrated working that exists between care homes and primary and community health and social services. Methods A self-completion, online questionnaire was designed by the research team. Items on the different dimensions of integration (funding, administrative, organisational, service delivery, clinical care) were included. The survey was sent to a random sample of residential care homes with more than 25 beds (n = 621) in England in 2009. Responses were analysed using quantitative and qualitative methods. Results The survey achieved an overall response rate of 15.8%. Most care homes (78.7%) worked with more than one general practice. Respondents indicated that a mean of 14.1 professionals/ services (other than GPs) had visited the care homes in the last six months (SD 5.11, median 14); a mean of .39 (SD.163) professionals/services per bed. The most frequent services visiting were district nursing, chiropody and community psychiatric nurses. Many (60%) managers considered that they worked with the NHS in an integrated way, including sharing documents, engaging in integrated care planning and joint learning and training. However, some care home managers cited working practices dictated by NHS methods of service delivery and priorities for care, rather than those of the care home or residents, a lack of willingness by NHS professionals to share information, and low levels of respect for

  4. Randomised controlled trials in primary care: scope and application.

    PubMed Central

    Sheikh, Aziz; Smeeth, Liam; Ashcroft, Richard

    2002-01-01

    There is now widespread acknowledgement of the absence of a sound evidence base underpinning many of the decisions made in primary care. Randomised controlled trials represent the methodology of choicefor determining efficacy and effectiveness of interventions, yet researchers working in primary care have been reluctant to use intervention studies, favouring observational study designs. Unfamiliarity with the different trial designs now available, and the relative advantages and disadvantages conferred by each, may be one factor contributing to this paradox. In this paper, we consider the principal trial designs available to primary care researchers, discussing the contexts in which a particular design may prove most useful. This information will, we hope, also prove useful to primary care clinicians attempting to interpret trial findings. PMID:12236280

  5. Guideline for primary care management of headache in adults

    PubMed Central

    Becker, Werner J.; Findlay, Ted; Moga, Carmen; Scott, N. Ann; Harstall, Christa; Taenzer, Paul

    2015-01-01

    Abstract Objective To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care. Quality of evidence A comprehensive search was conducted for relevant guidelines and systematic reviews published between January 2000 and May 2011. The guidelines were critically appraised using the AGREE (Appraisal of Guidelines for Research and Evaluation) tool, and the 6 highest-quality guidelines were used as seed guidelines for the guideline adaptation process. Main message A multidisciplinary guideline development group of primary care providers and other specialists crafted 91 specific recommendations using a consensus process. The recommendations cover diagnosis, investigation, and management of migraine, tension-type, medication-overuse, and cluster headache. Conclusion A clinical practice guideline for the Canadian health care context was created using a guideline adaptation process to assist multidisciplinary primary care practitioners in providing evidence-informed care for patients with headache. PMID:26273080

  6. Open Mouth, Open Mind: Expanding the Role of Primary Care Nurse Practitioners.

    PubMed

    Clark, Carol A; Kent, Kathleen A; Jackson, Richard D

    2016-01-01

    Oral health is essential to overall health at any age, although in children it is particularly important because poor oral health can have a deleterious effect on deciduous and permanent dentition. For decades, oral health providers have urged primary care providers to incorporate oral health assessment, risk factor identification, parent education, and preventive therapy into routine well-child visits. Despite recommendations from various professional associations and governmental organizations, the incidence of dental disease in young children remains relatively unchanged. Although the literature has clearly demonstrated that preventive care treatments, such as the application of fluoride varnish performed in the primary care setting, improve oral health in children, very few primary care providers include oral health services in their well-child visits. The purpose of this article is to reduce the barriers and knowledge gaps identified in recent pediatric oral health research and educate primary care nurse practitioners on the application of fluoride varnish to reduce the risk of the development of dental caries in young children. PMID:27554397

  7. Efficacy of primary care in a nursing center.

    PubMed

    Helvie, C O

    1999-01-01

    Nursing opportunities have expanded beyond the traditional bedside role. Nurses serve in a variety of roles such as administrators, teachers, or primary care givers in a variety of settings. The role of primary care giver is a more recent role; it involves relatively independent nursing practice with clients who have acute or chronic illnesses. Client groups may include the elderly in high rise buildings, mothers and children at schools, or homeless and low-income populations at homeless shelters. This care is often provided in a nursing center. Nursing centers are nurse-managed centers in which nurses are accountable and responsible for care of clients; they are the primary provider of care and the one most seen by clients. Case managers may be in a position to refer patients to nursing centers or to work directly with nurse practitioners in nursing centers. However, questions about the primary care provided in nursing centers must be addressed for healthcare providers, insurance companies, and patients to be confident in the efficacy of this delivery system. Is the primary care comprehensive? Is it of high quality? Is it cost effective? Is it satisfactory to clients? These and other questions about the primary care provided in nursing centers must be answered to effect political and other changes needed to fulfill the role of nursing centers envisioned by early leaders of the movement. This article addresses questions related to the efficacy of primary care provided in nursing centers by family nurse practitioners. After defining efficacy, the discussion focuses on the components identified and studied in one nursing center and includes information on opportunities for case managers to utilize nursing centers for referral and appropriate follow-up of their patients.

  8. A literature review: polypharmacy protocol for primary care.

    PubMed

    Skinner, Mary

    2015-01-01

    The purpose of this literature review is to critically evaluate published protocols on polypharmacy in adults ages 65 and older that are currently used in primary care settings that may potentially lead to fewer adverse drug events. A review of OVID, CINAHL, EBSCO, Cochrane Library, Medline, and PubMed databases was completed using the following key words: protocol, guideline, geriatrics, elderly, older adult, polypharmacy, and primary care. Inclusion criteria were: articles in medical, nursing, and pharmacology journals with an intervention, protocol, or guideline addressing polypharmacy that lead to fewer adverse drug events. Qualitative and quantitative studies were included. Exclusion criteria were: publications prior to the year 1992. A gap exists in the literature. No standardized protocol for addressing polypharmacy in the primary care setting was found. Mnemonics, algorithms, clinical practice guidelines, and clinical strategies for addressing polypharmacy in a variety of health care settings were found throughout the literature. Several screening instruments for use in primary care to assess potentially inappropriate prescription of medications in the elderly, such as the Beers Criteria and the STOPP screening tool, were identified. However, these screening instruments were not included in a standardized protocol to manage polypharmacy in primary care. Polypharmacy in the elderly is a critical problem that may result in adverse drug events such as falls, hospitalizations, and increased expenditures for both the patient and the health care system. No standardized protocols to address polypharmacy specific to the primary care setting were identified in this review of the literature. Given the growing population of elderly in this country and the high number of medications they consume, it is critical to focus on the utilization of a standardized protocol to address the potential harm of polypharmacy in the primary care setting and evaluate its effects on

  9. Promoting Physical Activity in Primary Care

    PubMed Central

    Singer, Joel; Lindsay, Elizabeth A.; Wilson, Douglas M.C.

    1991-01-01

    The principle barriers preventing health care professionals from promoting physical activity include an incomplete understanding of the evidence linking physical activity and health, difficulty in translating research findings into a feasible and efficacious clinical intervention, resistance to adopting a preventive orientation, and concerns about the risks of physical activity. Low level activities likely provide benefit with little risk. PMID:21229089

  10. Primary Care Clinician Expectations Regarding Aging

    ERIC Educational Resources Information Center

    Davis, Melinda M.; Bond, Lynne A.; Howard, Alan; Sarkisian, Catherine A.

    2011-01-01

    Purpose: Expectations regarding aging (ERA) in community-dwelling older adults are associated with personal health behaviors and health resource usage. Clinicians' age expectations likely influence patients' expectations and care delivery patterns; yet, limited research has explored clinicians' age expectations. The Expectations Regarding Aging…

  11. Primary care management of depression in children and adolescents.

    PubMed

    Haefner, Judy

    2016-06-19

    Depression is the most common mental health disorder in children and adolescents, and primary care is often the first point of contact for children and adolescents with depression. Depression impacts all areas of life, impairing academics and interactions with family and friends. The purpose of this article is to help NPs identify and treat children and adolescents presenting with depression in the primary care setting. PMID:27214067

  12. Developmental paediatrics in primary care: what should we teach?

    PubMed Central

    Baird, G; Hall, D M

    1985-01-01

    There is little agreement about what constitutes good developmental paediatric practice at the level of primary care. Many of the available screening tests are intrinsically unsatisfactory or badly performed, but screening is only a small part of developmental paediatrics. Every primary care doctor should be familiar with the scientific basis of the subject even if a decision is made not to embark on a formal screening programme. PMID:2412629

  13. Management of psoriasis and its comorbidities in primary care.

    PubMed

    Aldeen, Taha; Basra, Mohammad

    Psoriasis is a common chronic disfiguring skin disease. Its management depends on the extent of disease, sites affected, comorbidities, and patient's background or lifestyle. In the UK, psoriasis treatment starts in the primary care with range of topical applications, including steroids, vitamin D analogues and coal tar. However, psoriasis is associated with physical, psychological and metabolic comorbidities which could not be improved by topical therapy. The aim of this review is to address the challenge in managing these comorbidities within primary care.

  14. The ascendancy of primary care: permanent or temporary?

    PubMed

    Barnett, A E

    1995-10-01

    The conventional wisdom strongly suggests a health care provider food chain for the future: Primary care physicians (PCPs), principally family practitioners, on the top playing the lead role, distantly followed by specialists, with hospitals and other ancillary services even further down the line. Is this a reasonable expectation? Will PCPs dominate the new systems? Or will they be but one of many equally necessary components of these developing integrated health care delivery organizations? Looking at the various models now developing, it would seem that future integrated delivery systems will utilize both PCPs and specialists, but with strong augmentation from a diverse assortment of other health care professionals, including nonphysician providers, educators, and administrators. To separate the illusion of primary care dominance of the coming health care system from the likely reality, we should first determine what is driving the apparent present demand for primary care physicians. Next, we will examine the possible and probable reactions to that demand from an economic standpoint and from the points of view of both health care professionals and the public. Finally, we must try to picture how health care provider organizations of the future are likely to look and how they will integrate their health care professionals.

  15. [Clinical bioethics for primary health care].

    PubMed

    González-de Paz, L

    2013-01-01

    The clinical decision making process with ethical implications in the area of primary healthcare differs from other healthcare areas. From the ethical perspective it is important to include these issues in the decision making model. This dissertation explains the need for a process of bioethical deliberation for Primary Healthcare, as well as proposing a method for doing so. The decision process method, adapted to this healthcare area, is flexible and requires a more participative Healthcare System. This proposal involves professionals and the patient population equally, is intended to facilitate the acquisition of responsibility for personal and community health.

  16. [Clinical bioethics for primary health care].

    PubMed

    González-de Paz, L

    2013-01-01

    The clinical decision making process with ethical implications in the area of primary healthcare differs from other healthcare areas. From the ethical perspective it is important to include these issues in the decision making model. This dissertation explains the need for a process of bioethical deliberation for Primary Healthcare, as well as proposing a method for doing so. The decision process method, adapted to this healthcare area, is flexible and requires a more participative Healthcare System. This proposal involves professionals and the patient population equally, is intended to facilitate the acquisition of responsibility for personal and community health. PMID:23608158

  17. From Efficacy to Effectiveness and Beyond: What Next for Brief Interventions in Primary Care?

    PubMed Central

    O’Donnell, Amy; Wallace, Paul; Kaner, Eileen

    2014-01-01

    Background: Robust evidence supports the effectiveness of screening and brief alcohol interventions in primary healthcare. However, lack of understanding about their “active ingredients” and concerns over the extent to which current approaches remain faithful to their original theoretical roots has led some to demand a cautious approach to future roll-out pending further research. Against this background, this paper provides a timely overview of the development of the brief alcohol intervention evidence base to assess the extent to which it has achieved the four key levels of intervention research: efficacy, effectiveness, implementation, and demonstration. Methods: Narrative overview based on (1) the results of a review of systematic reviews and meta-analyses of the effectiveness of brief alcohol intervention in primary healthcare and (2) synthesis of the findings of key additional primary studies on the improvement and evaluation of brief alcohol intervention implementation in routine primary healthcare. Results: The brief intervention field seems to constitute an almost perfect example of the evaluation of a complex intervention. Early evaluations of screening and brief intervention approaches included more tightly controlled efficacy trials and have been followed by more pragmatic trials of effectiveness in routine clinical practice. Most recently, attention has shifted to dissemination, implementation, and wider-scale roll-out. However, delivery in routine primary health remains inconsistent, with an identified knowledge gap around how to successfully embed brief alcohol intervention approaches in mainstream care, and as yet unanswered questions concerning what specific intervention component prompt the positive changes in alcohol consumption. Conclusion: Both the efficacy and effectiveness of brief alcohol interventions have been comprehensively demonstrated, and intervention effects seem replicable and stable over time, and across different study

  18. Direct observation of weight counselling in primary care: alignment with clinical guidelines.

    PubMed

    Antognoli, E L; Smith, K J; Mason, M J; Milliner, B R; Davis, E M; Harris-Haywood, S; Seeholzer, E; Smith, S; Flocke, S A

    2014-04-01

    Primary care physicians provide care to a disproportionate number of overweight and obese patients and are uniquely positioned to help patients manage their weight in the context of a continuity relationship. The US National Heart, Lung and Blood Institute (NHLBI) developed evidence-based guidelines for the effective and efficient care of overweight/obese patients, but little is known about the use of these guidelines in practice. To determine the content of weight discussions and assess the elements of the NHLBI guidelines that were accomplished, office visits of 544 adult, overweight/obese patients to 28 primary care physicians were observed and audio recorded. Associations between type of weight management discussion and patient, physician and visit characteristics were examined. Fifty per cent (n = 270) of visits included weight discussions; 47% and 38% included use of at least one NHLBI assessment or treatment element during discussions about weight, respectively. Only 35% (n = 193) of discussions included an assessment and treatment strategy; none included all NHLBI-recommended elements. Overall, adherence to guidelines was poor, particularly with regard to reporting body mass index to the patient, measuring waist circumference and setting realistic weight loss goals. Weight discussions did not clearly vary by the patient, physician or visit characteristics examined. These findings suggest opportunities to develop and further tailor resources for improved physician training in patient weight management communication and treatment techniques that are both consistent with current standards for effective, evidence-based care and efficient enough for routine use during busy primary care visits.

  19. Curing and Caring: The Work of Primary Care Physicians With Dementia Patients

    PubMed Central

    CarolinaApesoa-Varano, Ester; Barker, Judith C.; Hinton, Ladson

    2013-01-01

    The symbolic framework guiding primary care physicians’ (PCPs) practice is crucial in shaping the quality of care for those with degenerative dementia. Examining the relationship between the cure and care models in primary care offers a unique opportunity for exploring change toward a more holistic approach to health care. The aims of this study were to (a) explore how PCPs approach the care of patients with Alzheimer’s disease (AD), and (b) describe how this care unfolds from the physicians’ perspectives. This was a cross-sectional study of 40 PCPs who completed semistructured interviews as part of a dementia caregiving study. Findings show that PCPs recognize the limits of the cure paradigm and articulate a caring, more holistic model that addresses the psychosocial needs of dementia patients. However, caring is difficult to uphold because of time constraints, emotional burden, and jurisdictional issues. Thus, the care model remains secondary and temporary. PMID:21685311

  20. Strengthening weak primary care systems: steps towards stronger primary care in selected Western and Eastern European countries.

    PubMed

    Groenewegen, Peter P; Dourgnon, Paul; Greß, Stefan; Jurgutis, Arnoldas; Willems, Sara

    2013-11-01

    European health care systems are facing diverse challenges. In health policy, strong primary care is seen as key to deal with these challenges. European countries differ in how strong their primary care systems are. Two groups of traditionally weak primary care systems are distinguished. First a number of social health insurance systems in Western Europe. In these systems we identified policies to strengthen primary care by small steps, characterized by weak incentives and a voluntary basis for primary care providers and patients. Secondly, transitional countries in Central and Eastern Europe (CCEE) that transformed their state-run, polyclinic based systems to general practice based systems to a varying extent. In this policy review article we describe the policies to strengthen primary care. For Western Europe, Germany, Belgium and France are described. The CCEE transformed their systems in a completely different context and urgency of problems. For this group, we describe the situation in Estonia and Lithuania, as former states of the Soviet Union that are now members of the EU, and Belarus which is not. We discuss the usefulness of voluntary approaches in the context of acceptability of such policies and in the context of (absence of) European policies.

  1. Embracing a diversified future for US primary care.

    PubMed

    Hoff, Timothy

    2013-01-01

    Although less focused upon given the current emphasis on the patient-centered medical home innovation, the future for US primary care is arguably one that will be characterized by diversity in service delivery structures and personnel. The drivers of this diversity include increased patient demand requiring a larger number of primary care access points; the need for lower-cost delivery structures that can flourish in a low-margin business model; greater interest in primary care delivery by retailers and hospitals that see their involvement as a means to enhance their core business goals; the increased desire by non-physician providers to gain work independence; and a growing cadre of younger PCPs whose career and job preferences leave them open to working in a variety of different settings and structures. A key issue to ask of a more diversified primary care system is whether or not it will be characterized by competition or cooperation. While a competitive system would not be unexpected given historical and current trends, such a system would likely stunt the prospects for a full revitalization of US primary care. However, there is reason to believe that a cooperative system is possible and would be advantageous, given the mutual dependencies that already exist among primary care stakeholders, and additional steps that could be taken to enhance such dependencies even more into the future. PMID:23379778

  2. [Research and the recent evolution of primary health care].

    PubMed

    Palomo, L

    2002-01-01

    Primary care in Spain has undergone a burgeoning phase in the 80's, followed by a decade of stagnation in the 90's, with little creativity, a routinisation of tasks, and the set up of service port-folios and program-contracts. On the other hand, the recent changes in the orientation of the research promoted by the health administration, in favor of basic research, at the expense of health services research and clinical epidemiology, are in contrast with the importance of primary care as a natural setting for the management of many causal agents and risk factors for health. Despite such limitations, the culture of research has become present in many primary care centres and pharmacies, and primary care research is increasingly present in scientific journals. Nevertheless, it is necessary, also for the case of primary care, to manage research, in differentiated and specific ways, favoring priorization, evaluation and responsibility through flexible organisational formulas and information systems. This should include contracting procedures allowing for at least part-time research, as well as professional career models acknowledging research and teaching activities. Scientific and professional associations in primary care face the challenge of maintaning research projects, of increasing their presence among professionals, of formulating opinions regarding the problems of their sector, as well as of reinforcing their organizational and communication capabilities. PMID:11958755

  3. Nurse practitioners, canaries in the mine of primary care reform.

    PubMed

    Contandriopoulos, Damien; Brousselle, Astrid; Breton, Mylaine; Sangster-Gormley, Esther; Kilpatrick, Kelley; Dubois, Carl-Ardy; Brault, Isabelle; Perroux, Mélanie

    2016-06-01

    A strong and effective primary care capacity has been demonstrated to be crucial for controlling costs, improving outcomes, and ultimately enhancing the performance and sustainability of healthcare systems. However, current challenges are such that the future of primary care is unlikely to be an extension of the current dominant model. Profound environmental challenges are accumulating and are likely to drive significant transformation in the field. In this article we build upon the concept of "disruptive innovations" to analyze data from two separate research projects conducted in Quebec (Canada). Results from both projects suggest that introducing nurse practitioners into primary care teams has the potential to disrupt the status quo. We propose three scenarios for the future of primary care and for nurse practitioners' potential contribution to reforming primary care delivery models. In conclusion, we suggest that, like the canary in the coal mine, nurse practitioners' place in primary care will be an indicator of the extent to which healthcare system reforms have actually occurred. PMID:27085958

  4. Nurse practitioners, canaries in the mine of primary care reform.

    PubMed

    Contandriopoulos, Damien; Brousselle, Astrid; Breton, Mylaine; Sangster-Gormley, Esther; Kilpatrick, Kelley; Dubois, Carl-Ardy; Brault, Isabelle; Perroux, Mélanie

    2016-06-01

    A strong and effective primary care capacity has been demonstrated to be crucial for controlling costs, improving outcomes, and ultimately enhancing the performance and sustainability of healthcare systems. However, current challenges are such that the future of primary care is unlikely to be an extension of the current dominant model. Profound environmental challenges are accumulating and are likely to drive significant transformation in the field. In this article we build upon the concept of "disruptive innovations" to analyze data from two separate research projects conducted in Quebec (Canada). Results from both projects suggest that introducing nurse practitioners into primary care teams has the potential to disrupt the status quo. We propose three scenarios for the future of primary care and for nurse practitioners' potential contribution to reforming primary care delivery models. In conclusion, we suggest that, like the canary in the coal mine, nurse practitioners' place in primary care will be an indicator of the extent to which healthcare system reforms have actually occurred.

  5. The ethics of complex relationships in primary care behavioral health.

    PubMed

    Reiter, Jeff; Runyan, Christine

    2013-03-01

    Primary care settings are particularly prone to complex relationships that can be ethically challenging. This is due in part to three of the distinctive attributes of primary care: a whole family orientation; team-based care; and a longitudinal care delivery model. In addition, the high patient volume of primary care means that the likelihood of encountering ethically challenging relationships is probably greater than in a specialty setting. This article argues that one ethical standard of the American Psychological Association (APA, 2010, Ethical principles of psychologists and code of conduct, www.apa.org/ethics/code) (10.02, Therapy Involving Couples or Families) should be revised to better accommodate the work of psychologists in primary care. The corresponding Principles of Medical Ethics from the American Medical Association (AMA, 2012, Code of medical ethics: Current opinions with annotations, 2012-2013, Washington, DC: Author), most notably the principle regarding a physician's duty to "respect the rights of patients, colleagues, and other health professionals as well as safeguard privacy" are also noted. In addition, the article details how the three attributes of primary care often result in complex relationships, and provides suggestions for handling such relationships ethically.

  6. Primary care for those with severe and persistent mental illness.

    PubMed Central

    Crews, C; Batal, H; Elasy, T; Casper, E; Mehler, P S

    1998-01-01

    Historically, the medical care of persons with severe and persistent mental illness (SPMI) has been suboptimal. In many communities, large gaps exist in the continuum of services necessary to meet the medical needs of those patients, and existing services are not well coordinated. The effect of the managed mental health care on patients with SPMI remains to be seen, but it does not bode well for patients who are already at risk for being undertreated. We initiated primary care clinics exclusively for patients with SPMI because of our belief that integrating primary care and mental health services offers the best hope of improving health care for those patients. Our experience to date is instructive for other health care systems. PMID:9795595

  7. Hypertensive patients in primary health care: access, connection and care involved in spontaneous demands.

    PubMed

    Girão, Ana Lívia Araújo; Freitas, Consuelo Helena Aires de

    2016-06-01

    Objective To assess the impacts of inclusion of care for spontaneous demands in the treatment of hypertensive patients in primary health care. Methods Third generation qualitative assessment survey conducted with 16 workers in a Primary Care Health Unit (PHCU) of the city of Fortaleza, state of Ceara, in the period between July and September of 2015. To collect data, systematic field observation and semi-structured interviews were used, and the stages of thematic content analysis were adopted for data analysis. Results Participants revealed that access, connection and care are fundamental to the treatment of hypertension. However, they said that the introduction of free access for spontaneous demands compromised the flow of care in the hypertension programs. Conclusion A dichotomy between the practice of care recommended by health policies and the one existing in the reality of PHCUs was shown, causing evident losses to the care of hypertensive patients in primary care. PMID:27253602

  8. Primary Mental Health Care in Disasters: Armero, Colombia.

    ERIC Educational Resources Information Center

    Lima, Bruno R.

    This paper focuses on the mental health consequences of the disaster in Armero, Colombia which resulted from a volcanic eruption and mudslide, and highlights the role of the primary care worker in delivering mental health care to disaster victims. Eight characteristics of disasters that are closely related to their psychopathogenetic potential…

  9. Implementing a teenage health service in primary care.

    PubMed

    Green, Elizabeth; Larcombe, J; Horbury, I

    The health of teenagers is currently a priority of the NHS, with many schemes and projects being developed. There are documented difficulties for teenagers in accessing health care, especially within general practice. This article describes the development and evaluation of a tailor-made clinic in the primary care setting. PMID:16209395

  10. Primary health care in rural areas: an agenda for research.

    PubMed Central

    DeFriese, G H; Ricketts, T C

    1989-01-01

    The confluence of forces slowing the growth of the physician supply despite a continued shortage of primary care physicians, the encouragement of competitive medical practices that centralize resources in larger places, and the changing of the rural population's character to one of more dependence on medical care may bring on another "rural health crisis" in the decade ahead. PMID:2645252

  11. New concepts in primary care: prevention as policy.

    PubMed

    Tulchinsky, T H

    1983-08-01

    Prevention is a key element of primary health care, as defined by the Alma-Ata Conference and promoted by the World Health Organization. Developed as well as developing countries are giving renewed emphasis to prevention in the planning of health care. Israel has much to gain by placing high priority on prevention in its health policy.

  12. Assessing Health Literacy in Diverse Primary Care Settings

    ERIC Educational Resources Information Center

    McCune, Renee L.

    2010-01-01

    Patient health literacy skills are critical to effective healthcare communication and safe care delivery in primary care settings. Methods and strategies to identify patient health literacy (HL) capabilities and provider/staff knowledge, attitudes and beliefs (KAB) regarding HL must be known before addressing provider/staff communication skills.…

  13. A Medical Student Organized and Directed Primary Care Preceptorship

    ERIC Educational Resources Information Center

    Skinner, Stephen R.; Rogers, Kenneth D.

    1974-01-01

    The Western Pennsylvania Health Preceptorship Program was judged to be effective in introducing students to the practice of primary care medicine and the analyses of determinants of health in communities in Western Pennsylvania and in giving them an understanding of the organization and financing of medical care. (Editor/PG)

  14. PAIR UP for primary care excellence: perspectives from a primary healthcare provider in Singapore.

    PubMed

    Tan, Ngiap Chuan

    2014-03-01

    Singapore is facing an increasing noncommunicable disease burden due to its ageing population. Singapore's primary healthcare services, provided by both polyclinic physicians and private general practitioners, are available to the public at differential fees for service. The resultant disproportionate patient loads lead to dissatisfaction for both healthcare providers and consumers. This article describes the 'PAIR UP' approach as a potential endeavour to facilitate primary care physicians (PCPs) in public and private sectors to collaborate to deliver enhanced primary care in Singapore. PAIR UP is an acronym referring to Policy, Academic development, Integration of healthcare information system, Research in primary care, Utility and safety evaluation, and Practice transformation. The current healthcare landscape is favourable to test out this multipronged approach. PCPs in both sectors can ride on it and work together synergistically to provide quality primary care in Singapore.

  15. Ontario's attempt at primary care reform hits another snag

    PubMed Central

    OReilly, M

    1998-01-01

    Ontario is the latest province to step into the health care reform spotlight. Proponents hope its proposed series of primary care pilot projects, built around the concept of patient rostering, will improve the delivery of care. If the project goes ahead, doctors in 5 participating sites will be paid under a capitation system, with payments starting at $70.29 annually for men aged between 25 and 35. PMID:9861214

  16. System facilitators and barriers to discussing older driver safety in primary care settings

    PubMed Central

    Betz, Marian E.; Jones, Jacqueline; Carr, David B.

    2015-01-01

    Background Primary care physicians play a leading role in counseling older drivers, but discussions often do not occur until safety concerns arise. Prior work suggests that routine questioning about driving might facilitate these difficult conversations. Objective To explore system-level factors affecting driving discussions in primary care settings, in order to inform the design and implementation of a program supporting routine conversations. Methods This qualitative descriptive study used iterative interviews with providers (physicians, nurses, medical assistants, social workers, and administrative staff) working at two clinics (one geriatric, one general internal medicine) at a tertiary-care teaching hospital. General inductive techniques in transcript analysis were used to identify stakeholder-perceived system-level barriers and facilitators to routine conversations with older drivers. Results From fifteen interviews, four themes emerged: (1) complexity of defined provider roles within primary care setting (which can both support team work and hamper efficiency); (2) inadequate resources to support providers (including clinical prompts, local guides, and access to social workers and driving specialists); (3) gaps in education of providers and patients about discussing driving; and (4) suggested models to enhance provider conversations with older drivers (including following successful examples and using defined pathways integrated into the electronic medical record). A fifth theme was that participants characterized their experiences in terms of current and ideal states. Conclusions Physicians have been tasked with assessing older driver safety and guiding older patients through the process of “driving retirement.” Attention to system-level factors such as provider roles, resources, and training can support them in this process. PMID:25617342

  17. Medical students' attitudes toward underserved populations: changing associations with choice of primary care versus non-primary care residency.

    PubMed

    Wayne, Sharon; Timm, Craig; Serna, Lisa; Solan, Brian; Kalishman, Summers

    2010-05-01

    The number of medical students entering primary care residencies continues to decrease. The association between student attitudes toward underserved populations and residency choice has received little attention even though primary care physicians see a larger proportion of underserved patients than most other specialists. We evaluated attitudes toward underserved populations in 826 medical students using a standardized survey, and used logistic regression to assess the effect of attitudes, along with other variables, on selection of a primary care residency. We compared results between two groups defined by year of entry to medical school (1993-99 and 2000-05) to determine whether associations differed by time period. Students' attitudes regarding professional responsibility toward underserved populations remained high over the study period; however, there was a statistically. significant association between positive attitudes and primary care residency in the early cohort only. This association was not found in the more recent group.

  18. All in a Day's Work: Primary Teachers "Performing" and "Caring"

    ERIC Educational Resources Information Center

    Forrester, Gillian

    2005-01-01

    This article discusses the current nature of primary teachers' work, which is explored in terms of "performing" and "caring" activities. It considers how the education policies of successive Governments in the UK, particularly for England, have given rise to a "performance culture" in primary schools which emphasises targets, testing and tables…

  19. Routine Prenatal Care Visits by Provider Specialty in the United States, 2009-2010

    MedlinePlus

    ... of prenatal visits to non-ob/gyn providers did not differ by race and ethnicity group in ... Generally, women of different race and ethnicity groups did not differ in the percentage of prenatal care ...

  20. Disparities in Routine Breast Cancer Screening for Medicaid Managed Care Members with a Work-Limiting Disability

    PubMed Central

    Weir, Sharada; Posner, Heather E.; Zhang, Jianying; Jones, Whitney C.; Willis, Georgianna; Baxter, Jeffrey D.; Clark, Robin E.

    2011-01-01

    Objective Examine disparities in routine mammography for women who qualify for Medicaid, because of a work-limiting disability. Methods Individual-level data were obtained for women enrolled in Massachusetts Medicaid Managed Care plans who met the 2007 Healthcare Effectiveness Data and Information Set (HEDIS) criteria for the breast cancer screening measure (n=35,171). Disability status was determined from Medicaid eligibility records. Mammography screening was modeled using multivariate logistic regression. Separate models for women with and without a disability were also estimated. Results Although unadjusted breast cancer screening rates were roughly equal for women with and without disability, after adjusting for confounders disability status had a significant negative association with screening mammography (OR=0.74; p<0.0001). Living farther from a mammography facility or having a diagnosis of domestic violence reduced the odds of screening for women with disabilities, but not for other women. Having a higher illness burden was more detrimental to screening for women with a disability than for those without. Both groups benefited similarly from the first 26 ambulatory care visits, but the impact of additional visits on screening was much larger among women with disabilities. Conclusion Nationwide, rates of routine mammography for Medicaid managed care plans averaged below 50% in 2006. Given that a majority of eligible women served by Medicaid have disabilities, and studies have shown that women with disabilities are more likely to be diagnosed with late stage disease, a focus on improving rates of screening for women with disabilities is overdue. PMID:22340778

  1. Fundamental reform of payment for adult primary care: comprehensive payment for comprehensive care.

    PubMed

    Goroll, Allan H; Berenson, Robert A; Schoenbaum, Stephen C; Gardner, Laurence B

    2007-03-01

    Primary care is essential to the effective and efficient functioning of health care delivery systems, yet there is an impending crisis in the field due in part to a dysfunctional payment system. We present a fundamentally new model of payment for primary care, replacing encounter-based imbursement with comprehensive payment for comprehensive care. Unlike former iterations of primary care capitation (which simply bundled inadequate fee-for-service payments), our comprehensive payment model represents new investment in adult primary care, with substantial increases in payment over current levels. The comprehensive payment is directed to practices to include support for the modern systems and teams essential to the delivery of comprehensive, coordinated care. Income to primary physicians is increased commensurate with the high level of responsibility expected. To ensure optimal allocation of resources and the rewarding of desired outcomes, the comprehensive payment is needs/risk-adjusted and performance-based. Our model establishes a new social contract with the primary care community, substantially increasing payment in return for achieving important societal health system goals, including improved accessibility, quality, safety, and efficiency. Attainment of these goals should help offset and justify the costs of the investment. Field tests of this and other new models of payment for primary care are urgently needed. PMID:17356977

  2. Coordinating Mental Health Care across Primary Care and Schools: ADHD as a Case Example

    ERIC Educational Resources Information Center

    Power, Thomas J.; Blum, Nathan J.; Guevara, James P.; Jones, Heather A.; Leslie, Laurel K.

    2013-01-01

    Although primary care practices and schools are major venues for the delivery of mental health services to children, these systems are disconnected, contributing to fragmentation in service delivery. This paper describes barriers to collaboration across the primary care and school systems, including administrative and fiscal pressures, conceptual…

  3. Pediatric Primary Care Providers' Relationships with Mental Health Care Providers: Survey Results

    ERIC Educational Resources Information Center

    Pidano, Anne E.; Honigfeld, Lisa; Bar-Halpern, Miri; Vivian, James E.

    2014-01-01

    Background: As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental…

  4. Managing irritable bowel syndrome in primary care.

    PubMed

    Corsetti, Maura; Whorwell, Peter J

    2015-06-01

    The classic symptoms of irritable bowel syndrome (IBS) are abdominal pain, bloating and some form of bowel dysfunction. The pain is typically colicky in nature and can occur at any site although most commonly it is on the left side. The abdomen feels flat in the morning and then gradually becomes more bloated as the day progresses reaching a peak by late afternoon or evening. It then subsides again over night. Traditionally IBS is divided into diarrhoea, constipation or alternating subtypes. IBS patients frequently complain of one or more non-colonic symptoms, these include constant lethargy, low backache, nausea, bladder symptoms suggestive of an irritable bladder, chest pain and dyspareunia in women. The traditional view that IBS is a largely psychological condition is no longer tenable. Rectal bleeding, a family history of malignancy and a short history in IBS should always be treated with suspicion. Both pain and bowel dysfunction are often made worse by eating. It is recommended that a coeliac screening test is undertaken to rule out this condition. Other routine tests should include inflammatory markers such as CRP or ESR. Calprotectin is a marker for leukocytes in the stools and detects gastrointestinal inflammation. A negative test almost certainly rules out inflammatory bowel disease, especially in conjunction with a normal CRP. Fermentable carbohydrates can have a detrimental effect on IBS and this has led to the introduction of the low FODMAP diet.

  5. Evaluation of the Arkansas Medicaid Primary Care Physician Management Program

    PubMed Central

    Muller, Andreas; Baker, John A.

    1996-01-01

    Arkansas implemented a primary-care case-management program in February 1994. This study evaluates the program during its first 17 months. Using quarterly data collected for the Health Care Financing Administration (HCFA), a pooled cross-sectional time series analysis (1991:4-1995:2) estimates the effect of eligibles' program enrollment on expenditure (total, inpatient hospital, outpatient hospital, physicians, prescription drugs, laboratory and X-ray) and utilization measures (outpatient visits, physician visits, prescription drugs). The Arkansas Medicaid managed care program appears to have somewhat reduced growth in total vendor payments and also appears to have improved access to primary medical services. PMID:10165704

  6. Assessment and treatment of addictions in primary care.

    PubMed

    Ravetti, L M

    2000-01-01

    Most clinicians are faced with the challenge of providing care and treatment for patients who experience the chronic relapsing brain disease known as addiction. The purpose of this article is to increase awareness of techniques and tools available to primary care clinicians (PCCs) for assessing and treating addictions in the office or clinic setting. A review of the history, physical examination, laboratory tests, and diagnostics relevant to addictive illness will help PCCs to hone their skills in addiction management. Addiction screening instruments and brief interventions used in primary care are presented. Adjunct therapies designed to promote the biopsychosocial and spiritual well-being of patients who are addicted have shown promise. PMID:11271125

  7. Managing multimorbidity in primary care in patients with chronic respiratory conditions

    PubMed Central

    Morrison, Deborah; Agur, Karolina; Mercer, Stewart; Eiras, Andreia; González-Montalvo, Juan I; Gruffydd-Jones, Kevin

    2016-01-01

    The term multimorbidity is usually defined as the coexistence of two or more chronic conditions within an individual, whereas the term comorbidity traditionally describes patients with an index condition and one or more additional conditions. Multimorbidity of chronic conditions markedly worsens outcomes in patients, increases treatment burden and increases health service costs. Although patients with chronic respiratory disease often have physical comorbidities, they also commonly experience psychological problems such as depression and anxiety. Multimorbidity is associated with increased health-care utilisation and specifically with an increased number of prescription drugs in individuals with multiple chronic conditions such as chronic obstructive pulmonary disease. This npj Primary Care Respiratory Medicine Education Section case study involves a patient in a primary care consultation presenting several common diseases prevalent in people of this age. The patient takes nine different drugs at this moment, one or more pills for each condition, which amounts to polypharmacy. The problems related with polypharmacy recommend that a routine medication review by primary care physicians be performed to reduce the risk of adverse effects of polypharmacy among those with multiple chronic conditions. The primary care physician has the challenging role of integrating all of the clinical problems affecting the patient and reviewing all medicaments (including over-the-counter medications) taken by the patient at any point in time, and has the has the key to prevent the unwanted consequences of polypharmacy. Multimorbid chronic disease management can be achieved with the use of care planning, unified disease templates, use of information technology with appointment reminders and with the help of the wider primary care and community teams. PMID:27629064

  8. Managing multimorbidity in primary care in patients with chronic respiratory conditions.

    PubMed

    Morrison, Deborah; Agur, Karolina; Mercer, Stewart; Eiras, Andreia; González-Montalvo, Juan I; Gruffydd-Jones, Kevin

    2016-01-01

    The term multimorbidity is usually defined as the coexistence of two or more chronic conditions within an individual, whereas the term comorbidity traditionally describes patients with an index condition and one or more additional conditions. Multimorbidity of chronic conditions markedly worsens outcomes in patients, increases treatment burden and increases health service costs. Although patients with chronic respiratory disease often have physical comorbidities, they also commonly experience psychological problems such as depression and anxiety. Multimorbidity is associated with increased health-care utilisation and specifically with an increased number of prescription drugs in individuals with multiple chronic conditions such as chronic obstructive pulmonary disease. This npj Primary Care Respiratory Medicine Education Section case study involves a patient in a primary care consultation presenting several common diseases prevalent in people of this age. The patient takes nine different drugs at this moment, one or more pills for each condition, which amounts to polypharmacy. The problems related with polypharmacy recommend that a routine medication review by primary care physicians be performed to reduce the risk of adverse effects of polypharmacy among those with multiple chronic conditions. The primary care physician has the challenging role of integrating all of the clinical problems affecting the patient and reviewing all medicaments (including over-the-counter medications) taken by the patient at any point in time, and has the has the key to prevent the unwanted consequences of polypharmacy. Multimorbid chronic disease management can be achieved with the use of care planning, unified disease templates, use of information technology with appointment reminders and with the help of the wider primary care and community teams. PMID:27629064

  9. Coordinating Mental Health Care Across Primary Care and Schools: ADHD as a Case Example.

    PubMed

    Power, Thomas J; Blum, Nathan J; Guevara, James P; Jones, Heather A; Leslie, Laurel K

    2013-01-01

    Although primary care practices and schools are major venues for the delivery of mental health services to children, these systems are disconnected, contributing to fragmentation in service delivery. This paper describes barriers to collaboration across the primary care and school systems, including administrative and fiscal pressures, conceptual and linguistic differences between healthcare and educational professionals, role restrictions among professionals, and privacy laws. Strategies for overcoming these barriers that can be applied in both primary care and school settings are described. The paper has a primary focus on children with ADHD, but the principles and strategies described are applicable to children with a range of mental health and health conditions.

  10. Pressure and Friction Injuries in Primary Care.

    PubMed

    Phillips, Shawn; Seiverling, Elizabeth; Silvis, Matthew

    2015-12-01

    Pressure and friction injuries are common throughout the lifespan. A detailed history of the onset and progression of friction and pressure injuries is key to aiding clinicians in determining the underlying mechanism behind the development of the injury. Modifying or removing the forces that are creating pressure or friction is the key to both prevention and healing of these injuries. Proper care of pressure and friction injuries to the skin is important to prevent the development of infection. Patient education on positioning and ergonomics can help to prevent recurrence of pressure and friction injuries.

  11. [Primary care in a detention environment].

    PubMed

    Beer, Daniel; Gravier, Bruno

    2006-11-22

    Detention is a severe and psychologically traumatising form of withdrawal from society of people who, often, are already jeopardized or suffering from psychical or somatic diseases. Yet, the individual deprived of freedom has fundamental rights to obtain medical care that should be of equal quality than the general population. One of the numerous missions of the penitentiary practitioner is to fulfil his practice with total independence within a repressive environment, with multiple constraints of order, respecting both security and judiciary requirements and the fundamental ethical principles of penitentiary medicine.

  12. A Review of Guidelines for the Primary Prevention of Legionellosis in Long-Term Care Facilities.

    PubMed

    Barker, Kimberly A; Whitney, Ellen A; Blake, Sarah; Berkelman, Ruth L

    2015-10-01

    Legionellosis is an important public health problem in the United States and other countries, and residents of long-term care facilities (LTCFs) are at higher risk for Legionnaires' disease than the general population. In this study, we reviewed published US and international guidelines for the primary prevention of legionellosis in LTCFs, including nursing homes, skilled nursing facilities, assisted living facilities, and aged care facilities. The results of this review indicate that most guidelines emphasize adequate design and maintenance of water systems and water temperatures; however, guidance regarding routine preventative environmental testing for Legionella bacteria is not uniform among various jurisdictions, and facilities are generally left without clear guidance on this issue. In the United States, the Centers for Disease Control and Prevention does not recommend such testing in LTCFs, in contrast to the Veterans Health Administration and Environmental Protection Agency. Internationally, the World Health Organization recommends routine environmental testing, as do Ireland; France; The Netherlands; South Africa; Vienna, Austria; and Queensland, Australia. Among domestic and international guidelines in favor of environmental testing, recommendations on the frequency of testing for Legionella in water systems vary. Further research to inform recommendations on the usefulness of routine environmental testing and other measures for the primary prevention of legionellosis in this setting is needed.

  13. A Review of Guidelines for the Primary Prevention of Legionellosis in Long-Term Care Facilities.

    PubMed

    Barker, Kimberly A; Whitney, Ellen A; Blake, Sarah; Berkelman, Ruth L

    2015-10-01

    Legionellosis is an important public health problem in the United States and other countries, and residents of long-term care facilities (LTCFs) are at higher risk for Legionnaires' disease than the general population. In this study, we reviewed published US and international guidelines for the primary prevention of legionellosis in LTCFs, including nursing homes, skilled nursing facilities, assisted living facilities, and aged care facilities. The results of this review indicate that most guidelines emphasize adequate design and maintenance of water systems and water temperatures; however, guidance regarding routine preventative environmental testing for Legionella bacteria is not uniform among various jurisdictions, and facilities are generally left without clear guidance on this issue. In the United States, the Centers for Disease Control and Prevention does not recommend such testing in LTCFs, in contrast to the Veterans Health Administration and Environmental Protection Agency. Internationally, the World Health Organization recommends routine environmental testing, as do Ireland; France; The Netherlands; South Africa; Vienna, Austria; and Queensland, Australia. Among domestic and international guidelines in favor of environmental testing, recommendations on the frequency of testing for Legionella in water systems vary. Further research to inform recommendations on the usefulness of routine environmental testing and other measures for the primary prevention of legionellosis in this setting is needed. PMID:26155722

  14. A Randomized Controlled Trial Protocol to Evaluate the Effectiveness of an Integrated Care Management Approach to Improve Adherence Among HIV-Infected Patients in Routine Clinical Care: Rationale and Design

    PubMed Central

    Fredericksen, Rob J; Church, Anna; Harrington, Anna; Ciechanowski, Paul; Magnani, Jennifer; Nasby, Kari; Brown, Tyler; Dhanireddy, Shireesha; Harrington, Robert D; Lober, William B; Simoni, Jane; Safren, Stevan A; Edwards, Todd C; Patrick, Donald L; Saag, Michael S; Crane, Paul K; Kitahata, Mari M

    2016-01-01

    Background Adherence to antiretroviral medications is a key determinant of clinical outcomes. Many adherence intervention trials investigated the effects of time-intensive or costly interventions that are not feasible in most clinical care settings. Objective We set out to evaluate a collaborative care approach as a feasible intervention applicable to patients in clinical care including those with mental illness and/or substance use issues. Methods We developed a randomized controlled trial (RCT) investigating an integrated, clinic-based care management approach to improve clinical outcomes that could be integrated into the clinical care setting. This is based on the routine integration and systematic follow-up of a clinical assessment of patient-reported outcomes targeting adherence, depression, and substance use, and adapts previously developed and tested care management approaches. The primary health coach or care management role is provided by clinic case managers allowing the intervention to be generalized to other human immunodeficiency virus (HIV) clinics that have case managers. We used a stepped-care approach to target interventions to those at greatest need who are most likely to benefit rather than to everyone to maintain feasibility in a busy clinical care setting. Results The National Institutes of Health funded this study and had no role in study design, data collection, or decisions regarding whether or not to submit manuscripts for publication. This trial is currently underway, enrollment was completed in 2015, and follow-up time still accruing. First results are expected to be ready for publication in early 2017. Discussion This paper describes the protocol for an ongoing clinical trial including the design and the rationale for key methodological decisions. There is a need to identify best practices for implementing evidence-based collaborative care models that are effective and feasible in clinical care. Adherence efficacy trials have not led to

  15. [Sharing experiences: rotation in primary care in Posadas, Argentina].

    PubMed

    García-Garrido, A B; Caballero, L G; Basiuk, S

    2013-09-01

    Primary care should be the cornerstone of any health system. It is the first contact with the community health system of any country. The Declaration of Alma-Ata, 1978, seeks to provide the basis for the construction of a new health system that will allow the full exercise of the right to health. Carrying out an external rotation in Primary Care in Posadas, Misiones Province, Argentina, during medical training, in family medicine, offers an insight into how other health systems work, provide health care to the community in a Primary Care Center in a country with its similarities and differences like ours, follow the implementation of programs, working with family medicine residents in another country, and living a rewarding personal and professional experience. PMID:23746704

  16. [A general practitioners' program for primary care in Chile].

    PubMed

    Bass del Campo, Germán Camilo

    2015-01-01

    The public health system in Chile does not have a comprehensive development policy for physician resources in primary care, so there is currently a significant deficit of hours for medical care. The article contains a proposal for a "General Program for Primary Care Physicians", which aims to reduce the gap of general practitioners and specialists in primary care. The program proposes to integrate newly graduated physicians to work in the public medical offices with the subsequent possibility of applying for a scholarship specialty, and consecutively a return period as a specialist in the public health network. The immediate implementation of this program is perfectly feasible given the current availability of doctors, over 1400 medical graduates from universities. PMID:25826371

  17. [A general practitioners' program for primary care in Chile].

    PubMed

    Bass del Campo, Germán Camilo

    2015-03-13

    The public health system in Chile does not have a comprehensive development policy for physician resources in primary care, so there is currently a significant deficit of hours for medical care. The article contains a proposal for a "General Program for Primary Care Physicians", which aims to reduce the gap of general practitioners and specialists in primary care. The program proposes to integrate newly graduated physicians to work in the public medical offices with the subsequent possibility of applying for a scholarship specialty, and consecutively a return period as a specialist in the public health network. The immediate implementation of this program is perfectly feasible given the current availability of doctors, over 1400 medical graduates from universities.

  18. Welcome back? Frequent attenders to a pediatric primary care center.

    PubMed

    Klein, Melissa; Vaughn, Lisa M; Baker, Raymond C; Taylor, Trisha

    2011-09-01

    This study examines frequent attenders of a pediatric primary care clinic at a large urban children's hospital--who they are and their reasons for frequent attendance to the clinic. The literature suggests that some visits by frequent attenders may not be medically necessary, and these additional appointments may impair others' access to medical care within the same system. The key to eliminating excessive primary care visits is to determine if it is a problem in the primary care practice (quantify the problem), explore the reasons for the visits (from the patients' perspective), and then provide educational interventions that address the various causes for the extra visits and encourage the use of available resources, either ancillary services in the practice itself or resources and agencies available in the community (e.g. social service, legal aid).

  19. Oral health in the context of primary care in Brazil.

    PubMed

    Nascimento, Antonio C; Moysés, Simone T; Werneck, Renata I; Moysés, Samuel J

    2013-10-01

    This article presents an integrative literature review that analyses the advances and challenges in oral health care of the Brazilian primary health care system, based on a political agenda that envisages re-organising the unified health system (SistemaÚnico de Saúde - SUS). It is presumed that the actions suggested by the Alma-Ata Conference of 1978 are still up-to-date and relevant when adapted to the situation in Brazil. Several studies and policies are reviewed, including works demonstrating the importance of primary care as an organising platform in an integrated health-care network, Brazil's strategy for reorganising the primary care network known as the Family Health Strategy, and the National Oral Health Policy. This review discusses results obtained over the last twenty years, with special attention paid to changes in oral health-care practices, as well as the funding of action programmes and assistance cover. The conclusion is that oral healthcare in the Brazilian primary health care system has advanced over the past decades; however, serious obstacles have been experienced, especially with regard to the guarantee of universal access to services and funding. The continuous efforts of public managers and society should focus on the goal of achieving universal coverage for all Brazilians.

  20. Diagnosing and managing psychosis in primary care.

    PubMed

    Saunders, Kate; Brain, Susannah; Ebmeier, Klaus P

    2011-05-01

    Psychosis is broadly defined as the presence of delusions and hallucinations. It can be organic or functional. The former is secondary to an underlying medical condition, such as delirium or dementia, the latter to a psychiatric disorder, such as schizophrenia or bipolar disorder. The identification and treatment of psychosis is vital as it is associated with a 10% lifetime risk of suicide and significant social exclusion. Psychosis can be recognised by taking a thorough history, examining the patient's mental state and obtaining a collateral history. The history usually enables a distinction to be made between bipolar disorder, schizophrenia and other causes. Early symptoms often include low mood, declining educational or occupational functioning, poor motivation, changes in sleep, perceptual changes, suspiciousness and mistrust. The patient's appearance, e.g. unkempt or inappropriately attired, may reflect their predominant mental state. There may be signs of agitation, hostility or distractibility. Speech may be disorganised and difficult to follow or there may be evidence of decreased speech. Mood may be depressed or elated or change rapidly. Patients may describe abnormal thoughts and enquiry into thoughts of suicide should be routine. Disturbances of thought such as insertion or withdrawal may be present along with perceptual abnormalities i.e. illusions, hallucinations. Insight varies during the course of a psychotic illness but should be explored as it has implications for management. All patients presenting with first episode psychosis for which no organic cause can be found should be referred to the local early intervention service. In patients with a known diagnosis consider referral if there is: poor response or nonadherence to treatment; intolerable side effects; comorbid substance misuse; risk to self or others. PMID:21714473

  1. Using Complexity Theory to Build Interventions that Improve Health Care Delivery in Primary Care

    PubMed Central

    Litaker, David; Tomolo, Anne; Liberatore, Vincenzo; Stange, Kurt C; Aron, David

    2006-01-01

    Previous observational research confirms abundant variation in primary care practice. While variation is sometimes viewed as problematic, its presence may also be highly informative in uncovering ways to enhance health care delivery when it represents unique adaptations to the values and needs of people within the practice and interactions with the local community and health care system. We describe a theoretical perspective for use in developing interventions to improve care that acknowledges the uniqueness of primary care practices and encourages flexibility in the form of intervention implementation, while maintaining fidelity to its essential functions. PMID:16637958

  2. Potential of physician assistants to support primary care

    PubMed Central

    Bowen, Sarah; Botting, Ingrid; Huebner, Lori-Anne; Wright, Brock; Beaupre, Beth; Permack, Sheldon; Jones, Ian; Mihlachuk, Ainslie; Edwards, Jeanette; Rhule, Chris

    2016-01-01

    Abstract Objective To determine effective strategies for introducing physician assistants (PAs) in primary care settings and provide guidance to support ongoing provincial planning for PA roles in primary care. Design Time-series research design using multiple qualitative methods. Setting Manitoba. Participants Physician assistants, supervising family physicians, clinic staff, members of the Introducing Physician Assistants into Primary Care Steering Committee, and patients receiving care from PAs. Methods The PA role was evaluated at 6 health care sites between 2012 and 2014; sites varied in size, funding models, geographic locations (urban or rural), specifics of the PA role, and setting type (clinic or hospital). Semistructured interviews and focus groups were conducted; patient feedback on quality improvement was retrieved; observational methods were employed; and documents were reviewed. A baseline assessment was conducted before PA placement. In 2013, there was a series of interviews and focus groups about the introduction of PAs at the 3 initial sites; in 2014 interviews and focus groups included all 6 sites. Main findings The concerns that were expressed during baseline interviews about the introduction of PAs (eg, community and patient acceptance) informed planning. Most concerns that were identified did not materialize. Supervising family physicians, site staff, and patients were enthusiastic about the introduction of PAs. There were a few challenges experienced at the site level (eg, front-desk scheduling), but they were perceived as manageable. Unanticipated challenges at the provincial level were identified (eg, diagnostic test ordering). Increased attachment and improved access—the goals of introducing PAs to primary care—were only some of the positive effects that were reported. Conclusion This first systematic multisite evaluation of PAs in primary care in Canada demonstrated that with appropriate collaborative planning, PAs can effectively

  3. Electronic health records and support for primary care teamwork

    PubMed Central

    Draper, Kevin; Gourevitch, Rebecca; Cross, Dori A.; Scholle, Sarah Hudson

    2015-01-01

    Objective Consensus that enhanced teamwork is necessary for efficient and effective primary care delivery is growing. We sought to identify how electronic health records (EHRs) facilitate and pose challenges to primary care teams as well as how practices are overcoming these challenges. Methods Practices in this qualitative study were selected from those recognized as patient-centered medical homes via the National Committee for Quality Assurance 2011 tool, which included a section on practice teamwork. We interviewed 63 respondents, ranging from physicians to front-desk staff, from 27 primary care practices ranging in size, type, geography, and population size. Results EHRs were found to facilitate communication and task delegation in primary care teams through instant messaging, task management software, and the ability to create evidence-based templates for symptom-specific data collection from patients by medical assistants and nurses (which can offload work from physicians). Areas where respondents felt that electronic medical record EHR functionalities were weakest and posed challenges to teamwork included the lack of integrated care manager software and care plans in EHRs, poor practice registry functionality and interoperability, and inadequate ease of tracking patient data in the EHR over time. Discussion Practices developed solutions for some of the challenges they faced when attempting to use EHRs to support teamwork but wanted more permanent vendor and policy solutions for other challenges. Conclusions EHR vendors in the United States need to work alongside practicing primary care teams to create more clinically useful EHRs that support dynamic care plans, integrated care management software, more functional and interoperable practice registries, and greater ease of data tracking over time. PMID:25627278

  4. Humanization policy in primary health care: a systematic review

    PubMed Central

    Nora, Carlise Rigon Dalla; Junges, José Roque

    2013-01-01

    OBJECTIVE To analyze humanization practices in primary health care in the Brazilian Unified Health System according to the principles of the National Humanization Policy. METHODS A systematic review of the literature was carried out, followed by a meta-synthesis, using the following databases: BDENF (nursing database), BDTD (Brazilian digital library of theses and dissertations), CINAHL (Cumulative Index to nursing and allied health literature), LILACS (Latin American and Caribbean health care sciences literature), MedLine (International health care sciences literature), PAHO (Pan-American Health Care Organization Library) and SciELO (Scientific Electronic Library Online). The following descriptors were used: Humanization; Humanizing Health Care; Reception: Humanized care: Humanization in health care; Bonding; Family Health Care Program; Primary Care; Public Health and Sistema Único de Saúde (the Brazilian public health care system). Research articles, case studies, reports of experiences, dissertations, theses and chapters of books written in Portuguese, English or Spanish, published between 2003 and 2011, were included in the analysis. RESULTS Among the 4,127 publications found on the topic, 40 studies were evaluated and included in the analysis, producing three main categories: the first referring to the infrastructure and organization of the primary care service, made clear the dissatisfaction with the physical structure and equipment of the services and with the flow of attendance, which can facilitate or make difficult the access. The second, referring to the health work process, showed issues about the insufficient number of professionals, fragmentation of the work processes, the professional profile and responsibility. The third category, referring to the relational technologies, indicated the reception, bonding, listening, respect and dialog with the service users. CONCLUSIONS Although many practices were cited as humanizing they do not produce changes

  5. Taking consultation-liaison psychiatry into primary care.

    PubMed

    Kisely, Stephen; Campbell, Leslie Anne

    2007-01-01

    Up to 50% of patients seen in primary care have mental health problems, the severity and duration of their problems often being similar to those of individuals seen in the specialized sector. This article describes the reasons, advantages, and challenges of collaborative or shared care between primary and mental health teams, which are similar to those of consultation-liaison psychiatry. In both settings, clinicians deal with the complex interrelationships between medical and psychiatric disorders. Although initial models emphasized collaboration between family physicians, psychiatrists, and nurses, collaborative care has expanded to involve patients, psychologists, social workers, occupational therapists, pharmacists, and other providers. Several factors are associated with favorable patient outcomes. These include delivery of interventions in primary care settings by providers who have met face-to-face and/or have pre-existing clinical relationships. In the case of depression, good outcomes are particularly associated with approaches that combined collaborative care with treatment guidelines and systematic follow-up, especially for those with more severe illness. Family physicians with access to collaborative care also report greater knowledge, skills, and comfort in managing psychiatric disorders, even after controlling for possible confounders such as demographics and interest in psychiatry. Perceived medico-legal barriers to collaborative care can be addressed by adequate personal professional liability protection on the part of each practitioner, and ensuring that other health care professionals with whom they work collaboratively are similarly covered.

  6. Turkish Primary School Students' Strategies in Solving a Non-Routine Mathematical Problem and Some Implications for the Curriculum Design and Implementation

    ERIC Educational Resources Information Center

    Erdogan, Abdulkadir

    2015-01-01

    Turkish primary mathematics curriculum emphasizes the role of problem solving for teaching mathematics and pays particular attention to problem solving strategies. Patterns as a subject and the use of patterns as a non-routine problem solving strategy are also emphasized in the curriculum. The primary purpose of this study was to determine how…

  7. Sharing resources: opportunities for smaller primary care practices to increase their capacity for patient care. Findings from the 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

    PubMed

    Fryer, Ashley-Kay; Doty, Michelle M; Audet, Anne-Marie J

    2011-03-01

    Most Americans get their health care in small physician practices. Yet, small practice settings are often unable to provide the same range of services or partici­pate in quality improvement initiatives as large practices because they lack the staff, infor­mation technology, and office systems. One promising strategy is to share clinical sup­port services and information systems with other practices. New findings from the 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians suggest smaller practices that share resources are more likely than those without shared resources to have advanced electronic medical records and health information technology, routinely track and manage patient information, have after-hours care arrangements, and engage in quality monitoring and benchmarking. This issue brief highlights strategies that can increase resources among small- and medium-sized practices and efforts supported by states, the private sector, and the Affordable Care Act that encourage the expansion of shared-resource models.

  8. Staff Group Unanimity in the Care of Juveniles in Institutional Treatment: Routines, Rituals, and Relationships

    ERIC Educational Resources Information Center

    Ahonen, Lia; Degner, Jurgen

    2013-01-01

    One prerequisite for effective institutional care is that staff agree on how to deliver treatment and have a unified view of how to achieve change--in other words, to have staff group unanimity (SGU). This study used the Correctional Program Assessment Inventory (CPAI) 2000, interviews with key staff, and observations of daily activities to…

  9. [Indicators in primary care: reality or desire. SESPAS report 2012].

    PubMed

    Ichaso Hernández-Rubio, M A de los Santos; García Armesto, Sandra

    2012-03-01

    The aim of this article is two-fold: firstly, to illustrate international experiences of assessing primary care performance by using examples of both cross-country comparisons and national assessment efforts and, secondly, to describe the progress achieved to date in the articulation of the Spanish Primary Care Information System. The central role assigned to primary care in conceptual frameworks clashes with the severe limitations in the quality and availability of the data required to construct the indicators. The lack of systematic and standardized databases covering diagnosis, procedures and intermediate results in individual patients is endemic across countries. Filling this gap has become a priority in most countries, especially during the last decade. In Spain, the concept of the Primary Care Information System appeared in 2003 and the first data/results were published in 2006. Since then, distinct elements have been progressively incorporated with the involvement of the various autonomous regions in Spain. Currently, the system includes various aspects such as the population assigned, the available resources, a national catalogue of primary care centers, and activity. The next challenge in this work in progress is to build a database of clinical information. PMID:22152924

  10. Primary care for children with autism.

    PubMed

    Carbone, Paul S; Farley, Megan; Davis, Toby

    2010-02-15

    The earliest sign of autism in children is the delayed attainment of social skill milestones, including joint attention, social orienting, and pretend play. Language impairment is a common, but less specific, sign of autism. Repetitive behaviors and restricted interests may not be noted until after social skill and communication impairments are exhibited. Physicians should perform developmental surveillance at all well-child visits, and the American Academy of Pediatrics recommends administering an autism-specific screening tool at the 18- and 24-month visits. A referral for comprehensive diagnostic evaluation is appropriate if concerns arise from surveillance, screening, or parental observations. The goals of long-term management are to maximize functional independence and community engagement, minimize maladaptive behaviors, and provide family and caregiver support. Physicians play an important role in coordinating care through an interdisciplinary team; referring families for specialized services; and treating children's associated conditions, including sleep disturbances, gastrointestinal problems, anxiety, and hyperactivity. Autism is a lifelong condition, but early recognition, diagnosis, and treatment can improve the prognosis, whereas associated medical conditions, psychiatric conditions, and intellectual disability can worsen the prognosis. PMID:20148499

  11. Primary care for children with autism.

    PubMed

    Carbone, Paul S; Farley, Megan; Davis, Toby

    2010-02-15

    The earliest sign of autism in children is the delayed attainment of social skill milestones, including joint attention, social orienting, and pretend play. Language impairment is a common, but less specific, sign of autism. Repetitive behaviors and restricted interests may not be noted until after social skill and communication impairments are exhibited. Physicians should perform developmental surveillance at all well-child visits, and the American Academy of Pediatrics recommends administering an autism-specific screening tool at the 18- and 24-month visits. A referral for comprehensive diagnostic evaluation is appropriate if concerns arise from surveillance, screening, or parental observations. The goals of long-term management are to maximize functional independence and community engagement, minimize maladaptive behaviors, and provide family and caregiver support. Physicians play an important role in coordinating care through an interdisciplinary team; referring families for specialized services; and treating children's associated conditions, including sleep disturbances, gastrointestinal problems, anxiety, and hyperactivity. Autism is a lifelong condition, but early recognition, diagnosis, and treatment can improve the prognosis, whereas associated medical conditions, psychiatric conditions, and intellectual disability can worsen the prognosis.

  12. Primary Care Endocrinology in the Adult Woman.

    PubMed

    Thomas, Celeste C; Zeytinoglu, Meltem

    2016-06-01

    Diabetes mellitus, thyroid disorders, and osteoporosis are endocrine conditions affecting a significant proportion of women presenting to the obstetrician-gynecologist. Obstetrician-gynecologists are often the first health-care providers that young women see in adulthood, and thus, have a critical opportunity to identify women at risk for gestational and overt diabetes and manage the condition in those who have developed it. The obstetrician-gynecologist should be aware of the appropriate therapeutic options and treatment goals (eg, hemoglobin A1c) for women with diabetes. Thyroid disorders often present with menstrual irregularities or infertility, can affect pregnancy outcomes, and contribute to cardiovascular and bone disorders as women age. Finally, osteoporosis and low bone mineral density affect a substantial proportion of older women and some younger women with risk factors for secondary osteoporosis. The morbidity and mortality of osteoporotic fractures is substantial. There are many lifestyle interventions and therapeutic options available for these conditions, and the gynecologist plays a key role in optimizing risk factor assessment, screening, and providing treatment when appropriate.

  13. Multiple sclerosis: a primary care perspective.

    PubMed

    Saguil, Aaron; Kane, Shawn; Farnell, Edwin

    2014-11-01

    Multiple sclerosis (MS) is the most common permanently disabling disorder of the central nervous system in young adults. Relapsing remitting MS is the most common type, and typical symptoms include sensory disturbances, Lhermitte sign, motor weakness, optic neuritis, impaired coordination, and fatigue. The course of disease is highly variable. The diagnosis is clinical and involves two neurologic deficits or objective attacks separated in time and space. Magnetic resonance imaging is helpful in confirming the diagnosis and excluding mimics. Symptom exacerbations affect 85% of patients with MS. Corticosteroids are the treatment of choice for patients with acute, significant symptoms. Disease-modifying agents should be initiated early in the treatment of MS to forestall disease and preserve function. Two immunomodulatory agents (interferon beta and glatiramer) and five immunosuppressive agents (fingolimod, teriflunomide, dimethyl fumarate, natalizumab, and mitoxantrone) are approved by the U.S. Food and Drug Administration for the treatment of MS, each with demonstrated effectiveness and unique adverse effect profiles. Symptom management constitutes a large part of care; neurogenic bladder and bowel, sexual dysfunction, pain, spasticity, and fatigue are best treated with a multidisciplinary approach to improve quality of life. PMID:25368924

  14. Implementation and spread of interventions into the multilevel context of routine practice and policy: implications for the cancer care continuum.

    PubMed

    Yano, Elizabeth M; Green, Lawrence W; Glanz, Karen; Ayanian, John Z; Mittman, Brian S; Chollette, Veronica; Rubenstein, Lisa V

    2012-05-01

    The promise of widespread implementation of efficacious interventions across the cancer continuum into routine practice and policy has yet to be realized. Multilevel influences, such as communities and families surrounding patients or health-care policies and organizations surrounding provider teams, may determine whether effective interventions are successfully implemented. Greater recognition of the importance of these influences in advancing (or hindering) the impact of single-level interventions has motivated the design and testing of multilevel interventions designed to address them. However, implementing research evidence from single- or multilevel interventions into sustainable routine practice and policy presents substantive challenges. Furthermore, relatively few multilevel interventions have been conducted along the cancer care continuum, and fewer still have been implemented, disseminated, or sustained in practice. The purpose of this chapter is, therefore, to illustrate and examine the concepts underlying the implementation and spread of multilevel interventions into routine practice and policy. We accomplish this goal by using a series of cancer and noncancer examples that have been successfully implemented and, in some cases, spread widely. Key concepts across these examples include the importance of phased implementation, recognizing the need for pilot testing, explicit engagement of key stakeholders within and between each intervention level; visible and consistent leadership and organizational support, including financial and human resources; better understanding of the policy context, fiscal climate, and incentives underlying implementation; explication of handoffs from researchers to accountable individuals within and across levels; ample integration of multilevel theories guiding implementation and evaluation; and strategies for long-term monitoring and sustainability. PMID:22623601

  15. Views of Dental Providers on Primary Care Coordination at Chairside: A Pilot Study

    PubMed Central

    Northridge, Mary E.; Birenz, Shirley; Gomes, Danni; Golembeski, Cynthia A.; Greenblatt, Ariel Port; Shelley, Donna; Russell, Stefanie L.

    2016-01-01

    Purpose There is a need for research to facilitate the widespread implementation, dissemination, and sustained utilization of evidence-based primary care screening, monitoring, and care coordination guidelines, thereby increasing the impact of dental hygienists’ actions on patients’ oral and general health. The aims of this formative study are to: (1) explore dental hygienists’ and dentists’ perspectives regarding the integration of primary care activities into routine dental care; and (2) assess the needs of dental hygienists and dentists regarding primary care coordination activities and use of information technology to obtain clinical information at chairside. Methods This qualitative study recruited ten hygienists and six dentists from ten New York City area dental offices with diverse patient mixes and volumes. A New York University faculty hygienist conducted semi-structured, in-depth interviews, which were digitally recorded and transcribed verbatim. Data analysis consisted of multilevel coding based on the Consolidated Framework for Implementation Research, resulting in emergent themes with accompanying categories. Results The dental hygienists and dentists interviewed as part of this study fail to use evidence-based guidelines to screen their patients for primary care sensitive conditions. Overwhelmingly, dental providers believe that tobacco use and poor diet contribute to oral disease, and report using electronic devices at chairside to obtain web-based health information. Conclusion Dental hygienists are well positioned to help facilitate greater integration of oral and general health care. Challenges include lack of evidence-based knowledge, coordination between dental hygienists and dentists, and systems-level support, with opportunities for improvement based upon a theory-driven framework. PMID:27340183

  16. Development and Validation of the Primary Care Team Dynamics Survey

    PubMed Central

    Song, Hummy; Chien, Alyna T; Fisher, Josephine; Martin, Julia; Peters, Antoinette S; Hacker, Karen; Rosenthal, Meredith B; Singer, Sara J

    2015-01-01

    Objective To develop and validate a survey instrument designed to measure team dynamics in primary care. Data Sources/Study Setting We studied 1,080 physician and nonphysician health care professionals working at 18 primary care practices participating in a learning collaborative aimed at improving team-based care. Study Design We developed a conceptual model and administered a cross-sectional survey addressing team dynamics, and we assessed reliability and discriminant validity of survey factors and the overall survey's goodness-of-fit using structural equation modeling. Data Collection We administered the survey between September 2012 and March 2013. Principal Findings Overall response rate was 68 percent (732 respondents). Results support a seven-factor model of team dynamics, suggesting that conditions for team effectiveness, shared understanding, and three supportive processes are associated with acting and feeling like a team and, in turn, perceived team effectiveness. This model demonstrated adequate fit (goodness-of-fit index: 0.91), scale reliability (Cronbach's alphas: 0.71–0.91), and discriminant validity (average factor correlations: 0.49). Conclusions It is possible to measure primary care team dynamics reliably using a 29-item survey. This survey may be used in ambulatory settings to study teamwork and explore the effect of efforts to improve team-based care. Future studies should demonstrate the importance of team dynamics for markers of team effectiveness (e.g., work satisfaction, care quality, clinical outcomes). PMID:25423886

  17. Utilizing education infrastructure for primary health care.

    PubMed

    Hope, R; Carter, C A; Rai, I M

    1988-01-01

    Sahar Matha Secondary School and Ghoretar Health Post serve approximately 30,000 people living in scattered communities over the steep foothills of the Himalaya in East Nepal. A pilot health education and sanitation project was implemented with the objectives of giving the secondary school students the knowledge and skills necessary for building domestic pit latrines in their villages. It was hoped that the students could be motivated to create enough awareness of the need for domestic pit latrines so that latrines would continue to be built after the pilot phase of the project. At the end of the 4 week building period there were 150 completed domestic pit latrines and 45 pits or partially complete latrines. Seeing pit latrine in Ghoretar at the school and health post had not been enough to motivate people to build their own domestic pit latrine. It seemed that people could understand the convenience of privacy in an area where there was no jungle cover, but did not appreciate the hygiene reasons for using pit latrines. It is now planned to extend the project into the 19 schools which feed the 2ndarty school, with the 2ndary school boy and girl scouts taking the health messages to the primary schools. Particular attention will be given to the teaching of modes disease transmission. So that the villagers can use their latrines hygienically.

  18. Utilizing education infrastructure for primary health care.

    PubMed

    Hope, R; Carter, C A; Rai, I M

    1988-01-01

    Sahar Matha Secondary School and Ghoretar Health Post serve approximately 30,000 people living in scattered communities over the steep foothills of the Himalaya in East Nepal. A pilot health education and sanitation project was implemented with the objectives of giving the secondary school students the knowledge and skills necessary for building domestic pit latrines in their villages. It was hoped that the students could be motivated to create enough awareness of the need for domestic pit latrines so that latrines would continue to be built after the pilot phase of the project. At the end of the 4 week building period there were 150 completed domestic pit latrines and 45 pits or partially complete latrines. Seeing pit latrine in Ghoretar at the school and health post had not been enough to motivate people to build their own domestic pit latrine. It seemed that people could understand the convenience of privacy in an area where there was no jungle cover, but did not appreciate the hygiene reasons for using pit latrines. It is now planned to extend the project into the 19 schools which feed the 2ndarty school, with the 2ndary school boy and girl scouts taking the health messages to the primary schools. Particular attention will be given to the teaching of modes disease transmission. So that the villagers can use their latrines hygienically. PMID:3341089

  19. Managed Medicare: an overview for the primary care physician.

    PubMed

    Colenda, C C; Sherman, F T

    1998-01-01

    Medicare is looking to managed care to help solve its financial burden. Because managed care plans offer a number of advantages for Medicare enrollees, the number of plans and of enrollees are increasing dramatically. With some exceptions, the Medicare population appears to do as well or better in HMOs as in fee-for-service care, despite differences in utilization of services. For the primary care physician, the key to success in managed Medicare is finding and aggressively managing your frail or near frail patients. Basic tools for survival are the use of prevention strategies, screening of enrollees and targeting for needed services, geriatric assessment, use of alternate care settings to avoid or limit costly hospital care, and monitoring of medication use for compliance and adverse reactions.

  20. Mexican patient satisfaction in a rural Minnesota primary care clinic.

    PubMed

    Rogers, Katelyn

    2008-08-01

    The Latino population in rural Minnesota has grown significantly in recent years. Despite the increase, few studies have considered whether these newcomers are satisfied with the care they receive from local medical clinics. This article describes the results of a pilot study that assessed 20 Mexican patients' satisfaction with care they received in a primary care clinic in rural central Minnesota. Participants were interviewed using questions from Stewart's Interpersonal Care Survey and open-ended questions. Results showed the patients were generally satisfied with their health care. However, they suggested improvements in the areas of communication and involvement in decisions. Answers to the open-ended questions suggested that even though patients seemed satisfied with their care, they still strongly desired a bilingual physician.

  1. The emerging primary care workforce: preliminary observations from the primary care team: learning from effective ambulatory practices project.

    PubMed

    Ladden, Maryjoan D; Bodenheimer, Thomas; Fishman, Nancy W; Flinter, Margaret; Hsu, Clarissa; Parchman, Michael; Wagner, Edward H

    2013-12-01

    Many primary care practices are changing the roles played by the members of their health care teams. The purpose of this article is to describe some of these new roles, using the authors' preliminary observations from 25 site visits to high-performing primary care practices across the United States in 2012-2013. These sites visits, to practices using their workforce creatively, were part of the Robert Wood Johnson Foundation-funded initiative, The Primary Care Team: Learning From Effective Ambulatory Practices.Examples of these new roles that the authors observed on their site visits include medical assistants reviewing patient records before visits to identify care gaps, ordering and administering immunizations using protocols, making outreach calls to patients, leading team huddles, and coaching patients to set self-management goals. The registered nurse role has evolved from an emphasis on triage to a focus on uncomplicated acute care, chronic care management, and hospital-to-home transitions. Behavioral health providers (licensed clinical social workers, psychologists, or licensed counselors) were colocated and integrated within practices and were readily available for immediate consults and brief interventions. Physicians have shifted from lone to shared responsibility for patient panels, with other team members empowered to provide significant portions of chronic and preventive care.An innovative team-based primary care workforce is emerging. Spreading and sustaining these changes will require training both health professionals and nonprofessionals in new ways. Without clinical experiences that model this new team-based care and role models who practice it, trainees will not be prepared to practice as a team.

  2. Health Information Technology Needs Help from Primary Care Researchers

    PubMed Central

    Krist, Alex H.; Green, Lee A.; Phillips, Robert L.; Beasley, John W.; DeVoe, Jennifer E.; Klinkman, Michael S.; Hughes, John; Puro, Jon; Fox, Chester H.; Burdick, Tim

    2015-01-01

    While health information technology (HIT) efforts are beginning to yield measurable clinical benefits, more is needed to meet the needs of patients and clinicians. Primary care researchers are uniquely positioned to inform the evidence-based design and use of technology. Research strategies to ensure success include engaging patient and clinician stakeholders, working with existing practice-based research networks, and using established methods from other fields such as human factors engineering and implementation science. Policies are needed to help support primary care researchers in evaluating and implementing HIT into everyday practice, including expanded research funding, strengthened partnerships with vendors, open access to information systems, and support for the Primary Care Extension Program. Through these efforts, the goal of improved outcomes through HIT can be achieved. PMID:25957361

  3. Delivering pharmacogenetic testing in a primary care setting

    PubMed Central

    Mills, Rachel; Voora, Deepak; Peyser, Bruce; Haga, Susanne B

    2013-01-01

    Pharmacogenetic testing refers to a type of genetic test to predict a patient’s likelihood to experience an adverse event or not respond to a given drug. Despite revision to several labels of commonly prescribed drugs regarding the impact of genetic variation, the use of this testing has been limited in many settings due to a number of factors. In the primary care setting, the limited office time as well as the limited knowledge and experience of primary care practitioners have likely attributed to the slow uptake of pharmacogenetic testing. This paper provides talking points for primary care physicians to discuss with patients when pharmacogenetic testing is warranted. As patients and physicians become more familiar and accepting of pharmacogenetic testing, it is anticipated that discussion time will be comparable to that of other clinical tests. PMID:24101877

  4. Primary care nurse practitioners' integrity when faced with moral conflict.

    PubMed

    Laabs, Carolyn Ann

    2007-11-01

    Primary care presents distressful moral problems for nurse practitioners (NPs) who report frustration, powerlessness, changing jobs and leaving advanced practice. The purpose of this grounded theory study was to describe the process NPs use to manage moral problems common to primary care. Twenty-three NPs were interviewed, commenting on hypothetical situations depicting ethical issues common to primary care. Coding was conducted using a constant comparative method. A theory of maintaining moral integrity emerged consisting of the phases of encountering conflict, drawing a line, finding a way without crossing the line, and evaluating actions. The NPs varied in their awareness and the discord encountered in conflict, and in clarity, flexibility and justification of the line drawn. A critical juncture occurred when NPs evaluated how well integrity had been maintained. Some experienced no distress while others experienced self-doubt, regret, outrage and frustration at external constraints, and attempted to reconcile through avoiding, convincing themselves, and compensating.

  5. Primary health care in an unsettled area of northern Thailand.

    PubMed

    Fox, P G; Komchum, S

    1992-01-01

    The implementation of primary health care by nurses in poor and geographically isolated areas of the world is a complex and difficult task. When the area is also unsettled and insecure the task becomes increasingly formidable. Under these conditions primary health care is bound by not only the allocation of resources and restricted mobility but also the instability of changing government policies that influence all parameters of life. Mounting evidence has demonstrated that self-determination--derived from community-based socio-economic development--is a prerequisite to the initiation of a successful health care system. In turn, socioeconomic development is possible only when people are secure from expulsion from their land and the country. In addition, they must also be protected against outside coercion and violence that undermines community stability. The following is a report on health care problems related to the socioeconomic instability of an unsettled area that has global implications for nurses in similar areas worldwide.

  6. Classic Citations in Main Primary Health Care Journals

    PubMed Central

    Li, Hongmei; Zhao, Xiyan; Zheng, Ping; Hu, Mei; Lu, Yan; Jia, Fukun; Tong, Xiaolin

    2015-01-01

    Abstract The impact of a publication in a particular medical area is reflected by the number of times the article is included as a citation. It is not known, however, which articles are cited the most in primary care journals. In our study, we aimed to identify the 100 most cited articles in primary care medicine and analyze their characteristics. We searched the Science Citation Index Expanded for articles published in 18 primary care journals using the subject category “Primary health care.” We identified 100 articles in primary health care that were the most cited. We analyzed the characteristics of these articles using the title, number of citations, citation density, year of publication, journal source, decade published, country of origin, institution, author names, and type of article. The 100 articles that were cited the most were published between the years 1977 and 2009. The 1990s decade was the most productive decade. The number of citations ranged from 117 to 775. The articles were published in 9 journals and the journal with the largest number of most cited articles (n = 33) was the Journal of Family Practice. This was followed by the British Journal of General Practice (n = 17) and the journal Family Practice (n = 16). The United States was the most productive country (n = 59); the United Kingdom was next (n = 25) and this was followed by Canada (n = 5) and The Netherlands (n = 5). The most popular article type was a review article and this was followed by a qualitative study and then methodological study. Our study provides insight into the historical development of primary care studies, based on citations, and provides the foundation for further investigations. PMID:26656360

  7. Screening and prevention in Swiss primary care: a systematic review

    PubMed Central

    Eisner, David; Zoller, Marco; Rosemann, Thomas; Huber, Carola A; Badertscher, Nina; Tandjung, Ryan

    2011-01-01

    Background and objectives Prevention is a challenging area of primary care. In Switzerland, little is known about attitudes to and performance of screening and prevention services in general practice. To implement prevention services in primary care it is important to know about not only potential facilitators but also barriers. Primary care encompasses the activities of general practitioners, including those with particular interest and/or specializations (eg, pediatrics, gynecology). The aim of this study was to review all studies with a focus on prevention services which have been conducted in Switzerland and to reveal barriers and facilitators for physicians to participate in any preventive measures. Methods The Cochrane Library, PubMed, EMBASE and BIOSIS were searched from January 1990 through December 2010. Studies focussing on preventive activities in primary care settings were selected and reviewed. The methodological quality of the identified studies was classified according to the guidelines in the Consolidated Standards of Reporting Trials (CONSORT) statement. Results We identified 49 studies including 45 descriptive studies and four randomised controlled trials (RCTs). Twelve studies addressed the prevention of epidemics, eleven out of them vaccinations. Further studies focused on lifestyle changes, physical activity counselling, smoking cessation, cardiovascular prevention and cancer screening. Perceived lack of knowledge/training and lack of time were the most commonly stated barriers. Motivation, feasibility and efficiency were the most frequently reported supporting factors for preventive activities. The methodological quality was weak, only one out of four RCTs met the applied quality criteria. Conclusion Most studies focussing on screening and prevention activities in primary care addressed vaccination, lifestyle modification or cardiovascular disease prevention. Identified barriers and facilitators indicate a need for primary-care

  8. Health transition in Africa: practical policy proposals for primary care

    PubMed Central

    Smeeth, L; Sekajugo, J

    2010-01-01

    Abstract Sub-Saharan Africa is undergoing health transition as increased globalization and accompanying urbanization are causing a double burden of communicable and noncommunicable diseases. Rates of communicable diseases such as HIV/AIDS, tuberculosis and malaria in Africa are the highest in the world. The impact of noncommunicable diseases is also increasing. For example, age-standardized mortality from cardiovascular disease may be up to three times higher in some African than in some European countries. As the entry point into the health service for most people, primary care plays a key role in delivering communicable disease prevention and care interventions. This role could be extended to focus on noncommunicable diseases as well, within the context of efforts to strengthen health systems by improving primary-care delivery. We put forward practical policy proposals to improve the primary-care response to the problems posed by health transition: (i) improving data on communicable and noncommunicable diseases; (ii) implementing a structured approach to the improved delivery of primary care; (iii) putting the spotlight on quality of clinical care; (iv) aligning the response to health transition with health system strengthening; and (v) capitalizing on a favourable global policy environment. Although these proposals are aimed at primary care in sub-Saharan Africa, they may well be relevant to other regions also facing the challenges of health transition. Implementing these proposals requires action by national and international alliances in mobilizing the necessary investments for improved health of people in developing countries in Africa undergoing health transition. PMID:21124720

  9. Finding the Primary Care Providers in the Specialist-Dominant Primary Care Setting of Korea: A Cluster Analysis

    PubMed Central

    Lee, Jin Yong; Eun, Sang Jun; Kim, Hyun Joo; Jo, Min-Woo

    2016-01-01

    Objective This study aimed to identify private clinics that have a potential to perform the role of primary care providers (PCPs) in a primary care setting in Korea where private specialists are dominant. Methods The 2013 National Patient Sample claim data of Health Insurance Review and Assessment Service in Korea was used. Two-step cluster analysis was performed using characteristics of private clinics, and patient and utilization characteristics of 27,797 private clinics. External validation of clusters was performed by assessing the association among clusters and outcomes of care provided by private clinics. Stability of clusters was cross-validated using discriminant analysis. Results The result classified more than a half of private clinics into a potential PCP cluster. These were private clinics with specialties considered to be those of primary care physicians and were more likely to be located in non-metropolitan areas than specialized PCPs were. Compared to specialized PCPs, they had a higher percentage of pediatric and geriatric patients, patients with greater disease severity, a higher percentage of patients with complex comorbidities or with simple or minor disease groups, a higher number of patients and visits, and the same or higher quality of primary care. The most important factor in explaining variations between PCP clusters was the number of simple or minor disease groups per patient. Conclusion This study identified potential PCPs and suggested the identifying criteria for PCPs. It will provide useful information for formulation of a primary care strengthening policy to policy makers in Korea as well as other countries with similar specialist-dominant primary care settings. PMID:27560181

  10. Education in the Wake of Healthcare Reform: Increasing Primary Care Usage by Individuals Currently Reliant upon Emergency Departments for Care

    ERIC Educational Resources Information Center

    Tannebaum, Michael; Wilkin, Holley A.; Keys, Jobia

    2014-01-01

    Background: The Affordable Care Act (ACA) was introduced, in part, to increase access to primary care, which has been shown to provide patients with myriad health benefits. Objective: To increase primary care usage by understanding the beliefs about primary and emergency care most salient to those whose healthcare-seeking practices may be impacted…

  11. Pediatric febrile seizures and childhood headaches in primary care.

    PubMed

    Reinhold, J; Bentti, A L

    2000-03-01

    Febrile seizures and migraine headaches in children are two of the most common neurological diagnoses seen by primary care practitioners. It is essential that a knowledge base be developed to better care for this population. This article reviews pediatric febrile seizures, including management and treatment recommendations and childhood headaches, with an emphasis on migraine headaches. Diagnosis, management, and referral criteria are also reviewed. PMID:10673570

  12. The work of a clinical psychologist in primary care.

    PubMed

    Johnston, M

    1978-11-01

    The data presented suggest that general practitioners would be likely to refer a large number of patients with diverse problems to clinical psychologists working in health centres. Compared with a centrally organized clinical psychology service, the work of the primary care psychologist is likely to offer the following advantages:1. Access to psychological help for patients with a need for such help, but who could not attend a central clinic owing to problems associated with travel, work, physical disability, or even a presenting problem such as agoraphobia.2. Greater continuity of care of patients.3. Increased communication between the psychologist and members of the primary care teams.4. Possibility of the psychologist seeing the patient earlier, before the problems have become entrenched.5. Less need for referral to other agencies.6. Reduced stigma for the patient.7. Development of new therapeutic approaches relevant to problems presenting in primary care.8. More flexible and more relevant therapy due to seeing the patients in their home setting.9. Greater therapeutic involvement of the patient's family.10. Reduced costs and inconvenience for the patient's family.11. Reduced administrative and ambulance service costs.While these points do not overcome the need for a formal evaluation of the work of psychologists in primary care, they do suggest that there are advantages in this type of service over the services which are currently available and that a full evaluation would be worth undertaking.

  13. Testing for Helicobacter pylori in primary care: trouble in store?

    PubMed Central

    Foy, R.; Parry, J. M.; Murray, L.; Woodman, C. B.

    1998-01-01

    STUDY OBJECTIVE: To assess the role of testing for Helicobacter pylori in the management of dyspeptic patients in primary care. DESIGN: Selective review of literature frequently quoted to support use of H pylori testing. MAIN RESULTS: Testing for H pylori and referral of only positive cases for endoscopy aims to reduce the number of "unnecessary" endoscopies. Patients with negative results may receive short-term reassurance and subsequently place fewer demands on health services. However, studies to date have only assessed this practice in secondary care settings. Given the relatively high prevalence of both dyspepsia and H pylori infection, the transfer of this practice to primary care may lead to a paradoxical increase in endoscopy referrals. Identification of H pylori and prescribing of eradication treatment also aims to reduce endoscopy referrals. No primary care trials have yet assessed this approach. Given that fewer than one in four of dyspeptic patients have peptic ulceration, a high proportion may fail to respond to eradication treatment and subsequently require referral for endoscopy. The longer term clinical and psychosocial sequelae of treating or labelling patients with an infection associated with gastric cancer remain unknown. CONCLUSIONS: Given uncertainty concerning the possible adverse effects of H pylori testing in primary care, we suggest a moratorium on its use in this setting until results from relevant clinical trials become available.   PMID:9764281

  14. Tuberculosis diagnosis: primary health care or emergency medical services?

    PubMed Central

    Andrade, Rubia Laine de Paula; Scatolin, Beatriz Estuque; Wysocki, Anneliese Domingues; Beraldo, Aline Ale; Monroe, Aline Aparecida; Scatena, Lúcia Marina; Villa, Tereza Cristina Scatena

    2013-01-01

    OBJECTIVE To assess primary health care and emergency medical services performance for tuberculosis diagnosis. METHODS Cross-sectional study were conducted with 90 health professionals from primary health care and 68 from emergency medical services, in Ribeirao Preto, SP, Southeastern Brazil, in 2009. A structured questionnaire based on an instrument of tuberculosis care assessment was used. The association between health service and the variables of structure and process for tuberculosis diagnosis was assessed by Chi-square test, Fisher's exact test (both with 5% of statistical significance) and multiple correspondence analysis. RESULTS Primary health care was associated with the adequate provision of inputs and human resources, as well as with the sputum test request. Emergencial medical services were associated with the availability of X-ray equipment, work overload, human resources turnover, insufficient availability of health professionals, unavailability of sputum collection pots and do not request sputum test. In both services, tuberculosis diagnosis remained as a physician's responsibility. CONCLUSIONS Emergencial medical services presented weaknesses in its structure to identify tuberculosis suspects. Gaps on the process were identified in both primary health care and emergencial medical services. This situation highlights the need for qualification of health services that are the main gateway to health system to meet sector reforms that prioritize the timely diagnosis of tuberculosis and its control. PMID:24626553

  15. The role of health promotion in primary health care.

    PubMed

    Stott, N C

    1986-05-01

    A major transformation has been occurring in primary health care during the past 20 years. The changes are reviewed briefly for the benefit of those who do not work in the front-line of care and for those who have not had the opportunity to experience the changes. Two major components of the transformation are stressed: (i) the shift towards person (patient) centred methods; (ii) a broad framework of reference which encourages horizontal integration of skills in the nonspecialized way. The opportunities for health promotion in primary health care are legion and evidence from worldwide experimental sources is reviewed to show how different levels of achievement can be demonstrated and monitored. Responsibility, empowerment and participation were firmly declared principles in the WHO Alma Ata Declaration on primary health care. The practical realisation of such principles in the field is occurring at an increasing rate, but their continuation will depend on the further growth and development of appropriate community-centred skills and practices. Evidence for the power of a "social sieve" to moderate professional or official health recommendations is also discussed in the light of current research. If recent research data is upheld, the relationship between primary health care personnel and the social network around them is likely to be shown to make a critical difference to health outcomes.

  16. Detecting cancer: Pearls for the primary care physician.

    PubMed

    Zeichner, Simon B; Montero, Alberto J

    2016-07-01

    Five-year survival rates have improved over the past 40 years for nearly all types of cancer, partially thanks to early detection and prevention. Since patients typically present to their primary care physician with initial symptoms, it is vital for primary care physicians to accurately diagnose common cancers and to recognize unusual presentations of highly curable cancers such as Hodgkin lymphoma and testicular cancers, for which the 5-year overall survival rates are greater than 85%. This paper reviews these cancers and provides clinically relevant pearls from an oncologic perspective for physicians who are the first point of contact.

  17. African primary care research: performing surveys using questionnaires.

    PubMed

    Govender, Indiran; Mabuza, Langalibalele H; Ogunbanjo, Gboyega A; Mash, Bob

    2014-04-25

    The aim of this article is to provide practical guidance on conducting surveys and the use of questionnaires for postgraduate students at a Masters level who are undertaking primary care research. The article is intended to assist with writing the methods section of the research proposal and thinking through the relevant issues that apply to sample size calculation, sampling strategy, design of a questionnaire and administration of a questionnaire. The articleis part of a larger series on primary care research, with other articles in the series focusing on the structure of the research proposal and the literature review, as well as quantitative data analysis.

  18. Detecting cancer: Pearls for the primary care physician.

    PubMed

    Zeichner, Simon B; Montero, Alberto J

    2016-07-01

    Five-year survival rates have improved over the past 40 years for nearly all types of cancer, partially thanks to early detection and prevention. Since patients typically present to their primary care physician with initial symptoms, it is vital for primary care physicians to accurately diagnose common cancers and to recognize unusual presentations of highly curable cancers such as Hodgkin lymphoma and testicular cancers, for which the 5-year overall survival rates are greater than 85%. This paper reviews these cancers and provides clinically relevant pearls from an oncologic perspective for physicians who are the first point of contact. PMID:27399864

  19. Implementation of pay for performance in primary care: a qualitative study 8 years after introduction

    PubMed Central

    Lester, Helen; Matharu, Tatum; Mohammed, Mohammed A; Lester, David; Foskett-Tharby, Rachel

    2013-01-01

    Background Pay for performance is now a widely adopted quality improvement initiative in health care. One of the largest schemes in primary care internationally is the English Quality and Outcomes Framework (QOF). Aim To obtain a longer term perspective on the implementation of the QOF. Design and setting Qualitative study with 47 health professionals in 23 practices across England. Method Semi-structured interviews. Results Pay for performance is accepted as a routine part of primary care in England, with previous more individualistic and less structured ways of working seen as poor practice. The size of the QOF and the evidence-based nature of the indicators are regarded as key to its success. However, pay for performance may have had a negative impact on some aspects of medical professionalism, such as clinical autonomy, and led a significant minority of GPs to prioritise their own pay rather than patients’ best interests. A small minority of GPs tried to increase their clinical autonomy with further unintended consequences. Conclusion Pay for performance indicators are now welcomed by primary healthcare teams and GPs across generations. Almost all interviewees wanted to see a greater emphasis on involving front line practice teams in developing indicators. However, almost all GPs and practice managers described a sense of decreased clinical autonomy and loss of professionalism. Calibrating the appropriate level of clinical autonomy is critical if pay for performance schemes are to have maximal impact on patient care. PMID:23735412

  20. Incomplete medication adherence of chronically ill patients in German primary care

    PubMed Central

    Hüther, Jakob; von Wolff, Alessa; Stange, Dorit; Härter, Martin; Baehr, Michael; Dartsch, Dorothee C; Kriston, Levente

    2013-01-01

    Background Incomplete medication adherence is a major problem in health care worldwide. Patients who adhere to medical treatment have a better prognosis and create fewer costs. Objective To assess the degree of incomplete adherence of chronically ill routine primary care patients in a German setting and analyze the association between incomplete medication adherence, as well as clinical and sociodemographic patient characteristics. Methods: In a cross-sectional survey, chronically ill patients were asked to assess their adherence in primary care retrospectively using the Medication Adherence Report Scale (MARS-D) questionnaire. To investigate the association of incomplete adherence with sociodemographic and clinical data, univariate and multivariate analyses were conducted. Results In total, 62.1% of 190 patients were categorized as incompletely adherent. The mean MARS-D score was 23.5 (standard deviation = 2.7). Analyses revealed no statistically significant associations at P < 0.05 between degree of adherence and patient characteristics. The total explained variance amounted to 11.8% (Nagelkerke’s R2 = 0.118) in the multivariate analysis. Conclusion Previously reported results regarding associations of sociodemographic and clinical data with incomplete medication adherence could not be confirmed for this sample of chronically ill patients. In order to be able to provide guidelines for the reduction of incomplete medication adherence in German primary care, further research is needed. PMID:23569363

  1. Contributions of Physical Therapists to Primary Preventive Health Care.

    PubMed

    Nomura, Takuo

    2016-01-01

    The limitations of what physical therapists can differ from country to country. In Japan, physical therapists are national licensed health care professionals who can help patients improve or restore their mobility. Most Japanese physical therapists provide care for people in health care facilities, medical-welfare transitional facilities, and welfare facilities for the elderly. Currently, physical therapists are unable to sufficiently contribute to primary preventive health care in Japan. However, there are many health problems that physical therapists could help alleviate. For example, low back pain (LBP) more likely than any other condition prevents people from working; thus, making the establishment of effective measures to prevent and reduce LBP vital. An estimated 20,500,000 Japanese individuals have diabetes mellitus (DM) or are at a high risk of developing the disease. DM commonly accompanies stroke and/or heart disease, and is characterized by complications that result from chronic hyperglycemia. Evidence-based physical therapy is effective for the prevention and treatment of LBP and DM. The Japanese Physical Therapy Association established the Japanese Society of Physical Therapy (JSPT) in June 2013. The JSPT has 12 departmental societies and 10 sections. We believe that the JSPT will advance the study of the potential role of physical therapists in primary preventive health care. In the future, it is expected that Japanese physical therapists will contribute to primary preventive health care. PMID:27246148

  2. Health care utilization, prognosis and outcomes of vestibular disease in primary care settings: systematic review.

    PubMed

    Grill, Eva; Penger, Mathias; Kentala, Erna

    2016-04-01

    Vertigo and dizziness are frequent complaints in primary care that lead to extensive health care utilization. The objective of this systematic review was to examine health care of patients with vertigo and dizziness in primary care settings. Specifically, we wanted to characterize health care utilization, therapeutic and referral behaviour and to examine the outcomes associated with this. A search of the MEDLINE and EMBASE databases was carried out in May 2015 using the search terms 'vertigo' or 'dizziness' or 'vestibular and primary care' to identify suitable studies. We included all studies that were published in the last 10 years in English with the primary diagnoses of vertigo, dizziness and/or vestibular disease. We excluded drug evaluation studies and reports of adverse drug reactions. Data were extracted and appraised by two independent reviewers; 16 studies with a total of 2828 patients were included. Mean age of patients ranged from 45 to 79 with five studies in older adults aged 65 or older. There were considerable variations in diagnostic criteria, referral and therapy while the included studies failed to show significant improvement of patient-reported outcomes. Studies are needed to investigate current practice of care across countries and health systems in a systematic way and to test primary care-based education and training interventions that improve outcomes. PMID:27083883

  3. Patients’ perceptions of the quality of care after primary care reform

    PubMed Central

    Tourigny, André; Aubin, Michele; Haggerty, Jeannie; Bonin, Lucie; Morin, Diane; Reinharz, Daniel; Leduc, Yvan; St-Pierre, Michele; Houle, Nathalie; Giguère, Anik; Benounissa, Zohra; Carmichael, Pierre-Hugues

    2010-01-01

    ABSTRACT OBJECTIVE To evaluate how a primary care reform, which aimed to promote interprofessional and interorganizational collaborative practices, affected patients’ experiences of the core dimensions of primary care. DESIGN Before-and-after comparison of patients’ perceptions of care at the beginning of family medicine group (FMG) implementation (15 to 20 months after accreditation) and 18 months later. SETTING Five FMGs in the province of Quebec from various settings and types of practice. PARTICIPANTS A random sample of patients was selected in each FMG; a total of 1046 participants completed both the baseline and follow-up questionnaires. MAIN OUTCOME MEASURES Patients’ perceptions of relational and informational continuity, organizational and first-contact accessibility, attitude and efficiency of the clinic’s personnel and waiting times (service responsiveness), physician-nurse and primary care physician–specialist coordination, and intra-FMG collaboration were assessed over the telephone, mostly using a modified version of the Primary Care Assessment Tool. Additional items covered patients’ opinions about consulting nurses, patients’ use of emergency services, and patients’ recall of health promotion and preventive care received. RESULTS A total of 1275 patients were interviewed at the study baseline, and 82% also completed the follow-up interviews after 18 months (n = 1046). Overall, perceptions of relational and informational continuity increased significantly (P < .05), whereas organizational and first-contact accessibility and service responsiveness did not change significantly. Perception of physician-nurse coordination remained unchanged, but perception of primary care physician–specialist coordination decreased significantly (P < .05). The proportion of participants reporting visits with nurses and reporting use of FMGs’ emergency services increased significantly from baseline to follow-up (P < .05). CONCLUSION This reorganization

  4. Parental perspectives regarding primary-care weight-management strategies for school-age children.

    PubMed

    Turer, Christy Boling; Mehta, Megha; Durante, Richard; Wazni, Fatima; Flores, Glenn

    2016-04-01

    To identify parental perspectives regarding weight-management strategies for school-age children, focus groups were conducted of parents of overweight and obese (body mass index ≥ 85th percentile) 6-12-year-old children recruited from primary-care clinics. Questions focused on the role of the primary-care provider, effective components of weight-management strategies and feasibility of specific dietary strategies. Focus groups were recorded, transcribed and analysed using margin coding and grounded theory. Six focus groups were held. The mean age (in years) for parents was 32, and for children, eight; 44% of participants were Latino, 33%, African-American and 23%, white. Parents' recommendations on the primary-care provider's role in weight management included monitoring weight, providing guidance regarding health risks and lifestyle changes, consistent follow-up and using discretion during weight discussions. Weight-management components identified as key included emphasising healthy lifestyles and enjoyment, small changes to routines and parental role modelling. Parents prefer guidance regarding healthy dietary practices rather than specific weight-loss diets, but identified principles that could enhance the acceptability of these diets. For dietary guidance to be feasible, parents recommended easy-to-follow instructions and emphasising servings over counting calories. Effective weight-management strategies identified by parents include primary-care provider engagement in weight management, simple instructions regarding healthy lifestyle changes, parental involvement and deemphasising specific weight-loss diets. These findings may prove useful in developing primary-care weight-management strategies for children that maximise parental acceptance. PMID:24720565

  5. Community-acquired pneumonia in primary care: clinical assessment and the usability of chest radiography

    PubMed Central

    Moberg, A.B.; Taléus, U.; Garvin, P.; Fransson, S.-G.; Falk, M.

    2016-01-01

    Objectives To investigate the diagnostic value of different clinical and laboratory findings in pneumonia and to explore the association between the doctor’s degree of suspicion and chest X-ray (CXR) result and to evaluate whether or not CXR should be used routinely in primary care, when available. Design A three-year prospective study was conducted between September 2011 and December 2014. Setting Two primary care settings in Linköping, Sweden. Subjects A total of 103 adult patients with suspected pneumonia in primary care. Main outcome measures The physicians recorded results of a standardized medical physical examination, including laboratory results, and rated their suspicion into three degrees. The outcome of the diagnostic variables and the degree of suspicion was compared with the result of CXR. Results Radiographic pneumonia was reported in 45% of patients. When the physicians were sure of the diagnosis radiographic pneumonia was found in 88% of cases (p < 0.001), when quite sure the frequency of positive CXR was 45%, and when not sure 28%. Elevated levels of C-reactive protein (CRP) ≥ 50mg/L were associated with the presence of radiographic pneumonia when the diagnosis was suspected (p < 0.001). Conclusion This study indicates that CXR can be useful if the physician is not sure of the diagnosis, but when sure one can rely on one’s judgement without ordering CXR. Key pointsThere are different guidelines but no consensus on how to manage community-acquired pneumonia in primary care.When the physician is sure of the diagnosis the judgement is reliable without chest X-ray and antibiotics can be safely prescribed.Chest X-ray can be useful in the assessment of pneumonia in primary care, when the physician is not sure of the diagnosis. PMID:26849394

  6. Parental perspectives regarding primary-care weight-management strategies for school-age children.

    PubMed

    Turer, Christy Boling; Mehta, Megha; Durante, Richard; Wazni, Fatima; Flores, Glenn

    2016-04-01

    To identify parental perspectives regarding weight-management strategies for school-age children, focus groups were conducted of parents of overweight and obese (body mass index ≥ 85th percentile) 6-12-year-old children recruited from primary-care clinics. Questions focused on the role of the primary-care provider, effective components of weight-management strategies and feasibility of specific dietary strategies. Focus groups were recorded, transcribed and analysed using margin coding and grounded theory. Six focus groups were held. The mean age (in years) for parents was 32, and for children, eight; 44% of participants were Latino, 33%, African-American and 23%, white. Parents' recommendations on the primary-care provider's role in weight management included monitoring weight, providing guidance regarding health risks and lifestyle changes, consistent follow-up and using discretion during weight discussions. Weight-management components identified as key included emphasising healthy lifestyles and enjoyment, small changes to routines and parental role modelling. Parents prefer guidance regarding healthy dietary practices rather than specific weight-loss diets, but identified principles that could enhance the acceptability of these diets. For dietary guidance to be feasible, parents recommended easy-to-follow instructions and emphasising servings over counting calories. Effective weight-management strategies identified by parents include primary-care provider engagement in weight management, simple instructions regarding healthy lifestyle changes, parental involvement and deemphasising specific weight-loss diets. These findings may prove useful in developing primary-care weight-management strategies for children that maximise parental acceptance.

  7. Commentary: Health care reform and primary care: training physicians for tomorrow's challenges.

    PubMed

    Caudill, T Shawn; Lofgren, Richard; Jennings, C Darrell; Karpf, Michael

    2011-02-01

    Although Congress recently passed health insurance reform legislation, the real catalyst for change in the health care delivery system, the author's argue, will be changes to the reimbursement model. To rein in increasing costs, the Centers for Medicare and Medicaid aims to move Medicare from the current fee-for-service model to a reimbursement approach that shifts the risk to providers and encourages greater accountability both for the cost and the quality of care. This level of increased accountability can only be achieved by clinical integration among health care providers. Central to this reorganized delivery model are primary care providers who coordinate and organize the care of their patients, using best practices and evidence-based medicine while respecting the patient's values, wishes, and dictates. Thus, the authors ask whether primary care physicians will be available in sufficient numbers and if they will be adequately and appropriately trained to take on this role. Most workforce researchers report inadequate numbers of primary care doctors today, a shortage that will only be exacerbated in the future. Even more ominously, the authors argue that primary care physicians being trained today will not have the requisite skills to fulfill their contemplated responsibilities because of a variety of factors that encourage fragmentation of care. If this training issue is not debated vigorously to determine new and appropriate training approaches, the future workforce may eventually have the appropriate number of physicians but inadequately trained individuals, a situation that would doom any effort at system reform.

  8. Do female primary care physicians practise preventive care differently from their male colleagues?

    PubMed Central

    Woodward, C. A.; Hutchison, B. G.; Abelson, J.; Norman, G.

    1996-01-01

    OBJECTIVE: To assess whether female primary care physicians' reported coverage of patients eligible for certain preventive care strategies differs from male physicians' reported coverage. DESIGN: A mailed survey. SETTING: Primary care practices in southern Ontario. PARTICIPANTS: All primary care physicians who graduated between 1972 and 1988 and practised in a defined geographic area of Ontario were selected from the Canadian Medical Association's physician resource database. Response rate was 50%. MAIN OUTCOME MEASURES: Answers to questions on sociodemographic and practice characteristics, attitudes toward preventive care, and perceptions about preventive care behaviour and practices. RESULTS: In general, reported coverage for Canadian Task Force on the Periodic Health Examination's (CTFPHE) A and B class recommendations was low. However, more female than male physicians reported high coverage of women patients for female-specific preventive care measures (i.e., Pap smears, breast examinations, and mammography) and for blood pressure measurement. Female physicians appeared to question more patients about a greater number of health risks. Often, sex of physician was the most salient factor affecting whether preventive care services thought effective by the CTFPHE were offered. However, when evidence for effectiveness of preventive services was equivocal or lacking, male and female physicians reported similar levels of coverage. CONCLUSION: Female primary care physicians are more likely than their male colleagues to report that their patients eligible for preventive health measures as recommended by the CTFPHE take advantage of these measures. PMID:8969856

  9. Maximizing nurse practitioners' contributions to primary care through organizational changes.

    PubMed

    Poghosyan, Lusine; Aiken, Linda H

    2015-01-01

    The nurse practitioner (NP) workforce represents a considerable supply of primary care providers able to contribute to meeting a growing demand for care. However, organizational barriers hinder their optimal use. This article presents reports from 592 NPs on their roles, organizational support available to them, relationships between NPs and administration, their job satisfaction, and intentions of leaving their jobs. Nurse practitioners reported deficits in organizational context of care, problematic deployment of resources, and unfavorable working relationships with administrators. Addressing these challenges and creating work environments conducive to NP practice are necessary to fully exploit the capacity of the NP workforce. PMID:25748259

  10. The impact of recent primary care reforms in the UK on interprofessional working in primary care centres.

    PubMed

    Elston, S; Holloway, I

    2001-02-01

    This study comprises the perspectives of professionals in primary care regarding the impact of the changes in its organisation and interprofessional collaboration in the UK. General practitioners (GPs), nurses and practice managers were interviewed in three primary cares located within a 20-mile radius and in the same health authority. Interviews were analysed using the grounded theory approach of Glaser & Strauss (1967) as developed by Strauss & Corbin (1998). The separate ideologies and subcultures of GPs, nurses and managers influenced their perceptions of reforms in primary care. Professional identities and the traditional power structure generated some conflict between the three groups which affected collaboration in implementing the reforms. Based on the findings of the study, it seems probable that it will take a new generation of health professionals to bring about an interprofessional culture in the NHS. PMID:11705067

  11. Barriers to obesity management: a pilot study of primary care clinicians

    PubMed Central

    Forman-Hoffman, Valerie; Little, Amanda; Wahls, Terry

    2006-01-01

    Background Obesity is an increasing epidemic in both the US and veteran populations, yet it remains largely understudied in the Veteran's Health Administration (VHA) setting. The purpose of our study was to identify barriers to the effective management of obesity in VHA primary care settings. Methods Three focus groups of clinicians from a Veteran's Affairs Medical Center (VAMC) and an affiliated Community Based Outpatient Center (CBOC) were conducted to identify potential barriers to obesity management. The focus groups and previously published studies then informed the creation of a 47-item survey that was then disseminated and completed by 55 primary care clinicians. Results The focus groups identified provider, system, and patient barriers to obesity care. Lack of obesity training during medical school and residency was associated with lower rates of discussing diet and exercise with obese patients (p < 0.05). Clinicians who watched their own diets vigorously were more likely to calculate BMI for obese patients than other clinicians (42% vs. 13%, p < 0.05). Many barriers identified in previous studies (e.g., attitudes toward obese patients, lack of insurance payments for obesity care) were not prevalent barriers in the current study. Conclusion Many VHA clinicians do not routinely provide weight management services for obese patients. The most prevalent barriers to obesity care were poor education during medical school and residency and the lack of information provided by the VHA to both clinicians and patients about available weight management services. PMID:16756673

  12. Under-diagnosis of pain by primary physicians and late referral to a palliative care team

    PubMed Central

    2012-01-01

    Background Under-diagnosis of pain is a serious problem in cancer care. Accurate pain assessment by physicians may form the basis of effective care. The aim of this study is to examine the association between late referral to a Palliative Care Team (PCT) after admission and the under-diagnosis of pain by primary physicians. Methods This retrospective study was performed in the Teikyo University teaching-hospital for a period of 20 months. We investigated triads composed of 213 adult cancer inpatients who had coexisting moderate or severe pain at the initial PCT consultation, 77 primary physicians, and 4 palliative care physicians. The outcome of the present study was the under-diagnosis of pain by primary physicians with routinely self-completed standard format checklists. The checklists included coexisting pain documented independently by primary and palliative care physicians at the time of the initial PCT consultation. Under-diagnosis of pain was defined as existing pain diagnosed by the palliative care physicians only. Late referral to PCTs after admission was defined as a referral to the PCT at ≥20 days after admission. Because the two groups displayed significantly different regarding the distributions of the duration from admission to referral to PCTs, we used 20 days as the cut-off point for “late referral.” Results Accurate pain assessment was observed in 192 triads, whereas 21 triads displayed under-diagnosis of pain by primary physicians. Under-diagnosis of pain by primary physicians was associated with a longer duration between admission and initial PCT consultation, compared with accurate pain assessment (25 days versus 4 days, p < 0.0001). After adjusting for potential confounding factors, under-diagnosis of pain by the primary physicians was significantly associated with late (20 or more days) referral to a PCT (adjusted odds ratio, 2.91; 95% confidence interval, 1.27 − 6.71). Other factors significantly associated with

  13. Administration to innovation: the evolving management challenge in primary care.

    PubMed

    Laing, A; Marnoch, G; McKee, L; Joshi, R; Reid, J

    1997-01-01

    The concept of the primary health-care team involving an increasingly diverse range of health care professionals is widely recognized as central to the pursuit of a primary care-led health service in the UK. Although GPs are formally recognized as the team leaders, there is little by way of policy prescription as to how team roles and relationships should be developed, or evidence as to how their roles have in fact evolved. Thus the notion of the primary health-care team while commonly employed, is in reality lacking definition with the current contribution of practice managers to the operation of this team being poorly understood. Focusing on the career backgrounds of practice managers, their range of responsibilities, and their involvement in innovation in general practice, presents a preliminary account of a chief scientist office-funded project examining the role being played by practice managers in primary health-care innovation. More specifically, utilizing data gained from the ongoing study, contextualizes the role played by practice managers in the primary health-care team. By exploring the business environment surrounding the NHS general practice, the research seeks to understand the evolving world of the practice manager. Drawing on questionnaire data, reinforced by qualitative data from the current interview phase, describes the role played by practice managers in differing practice contexts. This facilitates a discussion of a set of ideal type general practice organizational and managerial structures. Discusses the relationships and skills required by practice managers in each of these organizational types with reference to data gathered to date in the research.

  14. GOBI versus PHC? Some dangers of selective primary health care.

    PubMed

    Wisner, B

    1988-01-01

    This article enters the debate concerning comprehensive versus selective primary health care by focussing on UNICEF's 'child survival revolution'. It is argued that UNICEF is dangerously mistaken in believing that its present emphasis on selective primary health care is a precursor or 'leading edge' of comprehensive primary health care. The approach of UNICEF--diffusion of a package of technologies by campaigns organized from the top down--is more likely to undermine the social basis for comprehensive care. The kinds of implementation UNICEF has chosen in order to minimize costs and maximize impact on child mortality, namely 'social marketing' via mass media and massive, ad hoc delivery systems seriously undermine the development of grassroots organization among parents and primary health care workers. Indigenuous, local organizations are distorted and limited to conduits of a delivery system. Needs are defined outside the communities affected. In addition, UNICEF's so-called revolution has in common with other selective approaches an ideology accepting as inevitable the health effects of economic crisis in the 1980s, further undermining the confidence of local groups and health workers who might otherwise conceive of their desire to control health conditions as a right. The UNICEF interventions popularly known as GOBI-FFF are 'targetted' at individuals, in particular 'ignorant' mothers. As such they are especially destructive to the process of group formation and self-organization of the poor around their just demands for water and sanitation, land, shelter, and employment. This article concludes that UNICEF's GOBI should either be abandoned or integrated into comprehensive primary health care programs that put parents and local workers in control and that emphasize continuing political struggle for health rights. PMID:3388076

  15. Anxiety and diabetes: Innovative approaches to management in primary care.

    PubMed

    Bickett, Allison; Tapp, Hazel

    2016-09-01

    Type 2 diabetes mellitus is a chief concern for patients, healthcare providers, and health care systems in America, and around the globe. Individuals with type 2 diabetes mellitus exhibit clinical and subclinical symptoms of anxiety more frequently than people without diabetes. Anxiety is traditionally associated with poor metabolic outcomes and increased medical complications among those with type 2 diabetes mellitus. Collaborative care models have been utilized in the multidisciplinary treatment of mental health problems and chronic disease, and have demonstrated success in managing the pathology of depression which often accompanies diabetes. However, no specific treatment model has been published that links the treatment of anxiety to the treatment of type 2 diabetes mellitus. Given the success of collaborative care models in treating depression associated with diabetes, and anxiety unrelated to chronic disease, it is possible that the collaborative care treatment of primary care patients who suffer from both anxiety and diabetes could be met with the same success. The key issue is determining how to implement and sustain these models in practice. This review summarizes the proposed link between anxiety and diabetes, and offers an innovative and evidence-based collaborative care model for anxiety and diabetes in primary care. PMID:27390262

  16. Chiropractors as Primary Spine Care Providers: precedents and essential measures.

    PubMed

    Erwin, W Mark; Korpela, A Pauliina; Jones, Robert C

    2013-12-01

    Chiropractors have the potential to address a substantial portion of spinal disorders; however the utilization rate of chiropractic services has remained low and largely unchanged for decades. Other health care professions such as podiatry/chiropody, physiotherapy and naturopathy have successfully gained public and professional trust, increases in scope of practice and distinct niche positions within mainstream health care. Due to the overwhelming burden of spine care upon the health care system, the establishment of a 'primary spine care provider' may be a worthwhile niche position to create for society's needs. Chiropractors could fulfill this role, but not without first reviewing and improving its approach to the management of spinal disorders. Such changes have already been achieved by the chiropractic profession in Switzerland, Denmark, and New Mexico, whose examples may serve as important templates for renewal here in Canada.

  17. [Conceptual framework of integrated care and options for integration in primary care].

    PubMed

    Dózsa, Csaba; Borbás, Fanni

    2015-05-31

    Nowadays, several countries' health governments have recognized that the complex treatment of chronic diseases, prevention and rehabilitation requires a new approach. This study presents the possible solution of integrated service delivery in health and other sectors. Furthermore, it shows how the integration of primary care services was implemented and how the integration of different levels of providers changes the organization of care. This study is based on an overview of the relevant international literature, as well as the 5th European Primary Care Forum. The comprehensive approach of integrated care and adaption of the needs of local communities encourage the development of new organizational forms and services in primary care. The integrated service forms are more suitable to satisfy the needs of patients and communities and provide wide range of services, but it is important to find the appropriate dimensions of integration which would fit our goals.

  18. As accessible as a book on a library shelf: the imperative of routine simulation in modern health care.

    PubMed

    Gordon, James A

    2012-01-01

    Technology-enhanced patient simulation has emerged as an important new modality for teaching and learning in medicine. In particular, immersive simulation platforms that replicate the clinical environment promise to revolutionize medical education by enabling an enhanced level of safety, standardization, and efficiency across health-care training. Such an experiential approach seems unique in reliably catalyzing a level of emotional engagement that fosters immediate and indelible learning and allows for increasingly reliable levels of performance evaluation-all in a completely risk-free environment. As such, medical simulation is poised to emerge as a critical component of training and certification throughout health care, promising to fundamentally enhance quality and safety across disciplines. To encourage routine simulation-based practice as part of its core quality and safety mission, Massachusetts General Hospital now incorporates simulation resources within its historic medical library (est. 1847), located at the center of the campus. In this new model, learners go to the library not only to read about a patient's illness, but also to take care of their "patient." Such an approach redefines and advances the central role of the library on the campus and ensures that simulation-based practice is centrally available as part of everyday hospital operations. This article describes the reasons for identifying simulation as an institutional priority leading up to the Massachusetts General Hospital Bicentennial Celebration (1811-2011) and for creating a simulation-based learning laboratory within a hospital library.

  19. Wait times to rheumatology care for patients with rheumatic diseases: a data linkage study of primary care electronic medical records and administrative data

    PubMed Central

    Widdifield, Jessica; Bernatsky, Sasha; Thorne, J. Carter; Bombardier, Claire; Jaakkimainen, R. Liisa; Wing, Laura; Paterson, J. Michael; Ivers, Noah; Butt, Debra; Lyddiatt, Anne; Hofstetter, Catherine; Ahluwalia, Vandana; Tu, Karen

    2016-01-01

    Background: The Wait Time Alliance recently established wait time benchmarks for rheumatology consultations in Canada. Our aim was to quantify wait times to primary and rheumatology care for patients with rheumatic diseases. Methods: We identified patients from primary care practices in the Electronic Medical Record Administrative data Linked Database who had referrals to Ontario rheumatologists over the period 2000-2013. To assess the full care pathway, we identified dates of symptom onset, presentation in primary care and referral from electronic medical records. Dates of rheumatologist consultations were obtained by linking with physician service claims. We determined the duration of each phase of the care pathway (symptom onset to primary care encounter, primary care encounter to referral, and referral to rheumatologist consultation) and compared them with established benchmarks. Results: Among 2430 referrals from 168 family physicians, 2015 patients (82.9%) were seen by 146 rheumatologists within 1 year of referral. Of the 2430 referrals, 2417 (99.5%) occurred between 2005 and 2013. The main reasons for referral were osteoarthritis (32.4%) and systemic inflammatory rheumatic diseases (30.6%). Wait times varied by diagnosis and geographic region. Overall, the median wait time from referral to rheumatologist consultation was 74 (interquartile range 27-101) days; it was 66 (interquartile range 18-84) days for systemic inflammatory rheumatic diseases. Wait time benchmarks were not achieved, even for the most urgent types of referral. For systemic inflammatory rheumatic diseases, most of the delays occurred before referral. Interpretation: Rheumatology wait times exceeded established benchmarks. Targeted efforts are needed to promote more timely access to both primary and rheumatology care. Routine linkage of electronic medical records with administrative data may help fill important gaps in knowledge about waits to primary and specialty care. PMID:27398365

  20. Integrating mental health into primary health care in Zambia: a care provider's perspective

    PubMed Central

    2010-01-01

    Background Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative in nature and based in tertiary health institutions. At primary health care level, there is either absence of, or fragmented health services. Aims The aim of this paper was to explore health providers' views about mental health integration into primary health care. Methods A mixed methods, structured survey was conducted of 111 health service providers in primary health care centres, drawn from one urban setting (Lusaka) and one rural setting (Mumbwa). Results There is strong support for integrating mental health into primary health care from care providers, as a way of facilitating early detection and intervention for mental health problems. Participants believed that this would contribute to the reduction of stigma and the promotion of human rights for people with mental health problems. However, health providers felt they require basic training in order to enhance their knowledge and skills in providing health care to people with mental health problems. Recommendations It is recommended that health care providers should be provided with basic training in mental health in order to enhance their knowledge and skills to enable them provide mental health care to patients seeking help at primary health care level. Conclusion Integrating mental health services into primary health care is critical to improving and promoting the mental health of the population in Zambia. PMID:20653981

  1. Prospective assessment of quality of life in adult patients with primary brain tumors in routine neurooncology practice.

    PubMed

    Budrukkar, Ashwini; Jalali, Rakesh; Dutta, Debnarayan; Sarin, Rajiv; Devlekar, Rashmi; Parab, Sachin; Kakde, Anagha

    2009-12-01

    The aim of this article is to evaluate and assess the impact of various factors on quality of life (QOL) in adult patients with primary brain tumors seen consecutively in routine neurooncology practice. Two hundred and fifty-seven adult patients, after undergoing surgical intervention and histologically proven primary brain neoplasms were registered in the NeuroOncology Clinic at our centre during 1 full calendar year. The study included detailed neurological assessment, evaluation of QOL using EORTC questionnaire (QLQ-30) and specific Brain Cancer module (BN 20). In the present analysis, QOL scores before starting adjuvant treatment were measured and impact of patient and tumor related factors were analyzed. Baseline global QOL data of all patients (available in 243) was relatively low including in all histological tumor types. Physical function, role function, emotion function, cognitive and social function scores were 80, 78, 65.7, 70 and 70.5 (higher values better), respectively. Domains of future uncertainty, visual disorder, motor deficit, communication deficit, headache, seizures and drowsiness scores were 19.6, 18.2, 28.5, 30.7, 21, 31.8 and 16 (lower values better), respectively. Elderly patients had poorer global score (21 points difference; p = 0.161). Patients with lower performance status (KPS < 70) had a lower global QOL (KPS >or= 80 vs. primary brain tumours before starting adjuvant therapy have

  2. Primary care in nursing homes revisited: survey of the experiences of primary care physicians.

    PubMed

    Gleeson, L E; Jennings, S; Gavin, R; McConaghy, D; Collins, D R

    2014-09-01

    The Irish Health Information and Quality Authority (HIQA) published National Quality Standards for Residential Care Settings for Older People in 2009. We reported on experiences of general practitioners (GPs) in Dublin caring for nursing home patients (NHPs) in 2006. We revisit these experiences following publication of HIQA's standards. 400 GPs received an anonymous postal survey. Of 204 respondents, 145 (71%) felt NHPs required more contact time and 124 (61%) reported more complex consultations compared to other patients. Only 131 (64%) felt adequately trained in gerontology. 143 (70%) reported access to specialist advice, but only 6 (3%) reported a change in this following HIOA standards. 65 (32%) had witnessed substandard care in a NH, of which 16 (25%) made no report, similar figures to 2006. There remains similar levels of concern regarding patient complexity, substandard care, access to specialist support and training in the care of NHPs. Many GPs expressed uncertainty regarding their role in implementing HIQA standards.

  3. The new Australian Primary Health Networks: how will they integrate public health and primary care?

    PubMed

    Booth, Mark; Hill, Graham; Moore, Michael J; Dalla, Danielle; Moore, Michael G; Messenger, Anne

    2016-01-01

    On 1 July 2015, the Australian Government established 31 new Primary Health Networks (PHNs), following a review by its former Chief Medical Officer, John Horvath, of 61 Medicare Locals created under the previous Labor administration. The Horvath review recommended, among other things, that new, larger primary health organisations be established to reduce fragmentation of care by integrating and coordinating health services, supporting the role of general practice, and leveraging and administering health program funding. The two main objectives of the new PHNs, as stated on the Department of Health's website, are "increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, and improving coordination of care to ensure patients receive the right care in the right place at the right time". Below are three viewpoints, commissioned for this primary health care themed issue of Public Health Research & Practice, from the Australian Government Department of Health, the Public Health Association of Australia and a Sydney-based PHN. We asked the authors to focus particularly on how the newly established networks might help to integrate public health within the primary health care landscape. Our authors have pointed out the huge overlap between public health and primary care and looked at evidence showing the great benefits for health systems of collaboration between the two. Challenges ahead include a possible government focus on delivery of 'frontline' medical services, which may come at the expense of population health, and the complexity of dealing with all primary health care stakeholders, including health professionals, Local Health Districts, nongovernment organisations, research institutions and local communities. PMID:26863166

  4. An effort to spread decision aids in five California primary care practices yielded low distribution, highlighting hurdles.

    PubMed

    Lin, Grace A; Halley, Meghan; Rendle, Katharine A S; Tietbohl, Caroline; May, Suepattra G; Trujillo, Laurel; Frosch, Dominick L

    2013-02-01

    Despite the proven efficacy of decision aids as interventions for increasing patient engagement and facilitating shared decision making, they are not used routinely in clinical care. Findings from a project designed to achieve such integration, conducted at five primary care practices in 2010-12, document low rates of distribution of decision aids to eligible patients due for colorectal cancer screening (9.3 percent) and experiencing back pain (10.7 percent). There were also no lasting increases in distribution rates in response to training sessions and other promotional activities for physicians and clinic staff. The results of focus groups, ethnographic field notes, and surveys suggest that major structural and cultural changes in health care practice and policy are necessary to achieve the levels of use of decision aids and shared decision making in routine practice envisioned in current policy. Among these changes are ongoing incentives for use, physician training, and a team-based practice model in which all care team members bear formal responsibility for the use of decision aids in routine primary care.

  5. Adjuvant chemotherapy for colon carcinoma with positive lymph nodes: use and benefit in routine health care practice.

    PubMed

    Bouchardy, C; Queneau, P E; Fioretta, G; Usel, M; Zellweger, M; Neyroud, I; Raymond, L; de Wolf, C; Sappino, A P

    2001-11-01

    In 1990, an international consensus was reached on the efficacy of adjuvant chemotherapy for lymph node positive (stage III) colon carcinoma (CC). This study evaluates the use and benefit of such therapy in routine health care practice. The study includes all patients with stage III CC treated by putative curative surgery (n = 182) recorded at the Geneva cancer registry between 1990 and 1996. Factors modifying chemotherapy use were determined by logistic regression, considering patients with chemotherapy as cases (n = 55) and others as controls (n = 127). The effect of chemotherapy on the 5-year survival was evaluated by the Cox model. Analyses were adjusted for possible confounders. The use of chemotherapy increased over the period (P(trend) < 0.001). Age strongly modulated chemotherapy use. In 1996, 54% of eligible patients received chemotherapy, this proportion fell to 13% after age 70. Decisions to use chemotherapy significantly depended on stage, grade and cancer site. The chance to be treated was non-significantly lower among individuals of low social class, widowed and foreigners. Chemotherapy significantly decreased mortality rates (Hazard ratio: 0.35, 95%CI: 0.18-0.68), independently of the prognostic factors and with similar benefit regardless of stage and age group. Strong beneficial effect of adjuvant chemotherapy on stage III CC can be achieved in routine practice. However, this study shows that it is probably not optimally utilised in Switzerland, particularly among the elderly.

  6. Adjuvant chemotherapy for colon carcinoma with positive lymph nodes: use and benefit in routine health care practice

    PubMed Central

    Bouchardy, C; Queneau, P-E; Fioretta, G; Usel, M; Zellweger, M; Neyroud, I; Raymond, L; Wolf, C de; Sappino, A P

    2001-01-01

    In 1990, an international consensus was reached on the efficacy of adjuvant chemotherapy for lymph node positive (stage III) colon carcinoma (CC). This study evaluates the use and benefit of such therapy in routine health care practice. The study includes all patients with stage III CC treated by putative curative surgery (n= 182) recorded at the Geneva cancer registry between 1990 and 1996. Factors modifying chemotherapy use were determined by logistic regression, considering patients with chemotherapy as cases (n= 55) and others as controls (n= 127). The effect of chemotherapy on the 5-year survival was evaluated by the Cox model. Analyses were adjusted for possible confounders. The use of chemotherapy increased over the period (Ptrend < 0.001). Age strongly modulated chemotherapy use. In 1996, 54% of eligible patients received chemotherapy, this proportion fell to 13% after age 70. Decisions to use chemotherapy significantly depended on stage, grade and cancer site. The chance to be treated was non-significantly lower among individuals of low social class, widowed and foreigners. Chemotherapy significantly decreased mortality rates (Hazard ratio: 0.35, 95%CI: 0.18–0.68), independently of the prognostic factors and with similar benefit regardless of stage and age group. Strong beneficial effect of adjuvant chemotherapy on stage III CC can be achieved in routine practice. However, this study shows that it is probably not optimally utilised in Switzerland, particularly among the elderly. © 2001 Cancer Research Campaign PMID:11720457

  7. Designing primary health care teams for developing countries.

    PubMed Central

    Reisman, A; Duran, L

    1983-01-01

    A time-honored industrial engineering technique, job evaluation, which was developed to set rates for manual labor, was used in the design of new teams for delivering primary health care in Latin America. The technique was used both in writing job descriptions for new allied health personnel and in designing the curriculums needed to train the personnel. PMID:6856744

  8. Stopping the tsunami of stress in primary care.

    PubMed

    Pearson, Tamera

    2015-12-12

    This article provides an overview of the psychoneuroimmunologic impact of stress on illness along with a review of mind/body therapies to counteract the effects of stress. Primary care providers are encouraged to promote stress reduction and translate evidence into practice by recommending mind/body therapies.

  9. Social Workers Training Primary Care Physicians: Essential Psychosocial Principles.

    ERIC Educational Resources Information Center

    Zayas, Luis H.; Dyche, Larry A.

    1992-01-01

    Notes that growth of primary care medicine is opening new roles for social worker in medical education. Describes family-oriented, community-based medical residency program in which social work faculty plays prominent role in education of young physicians. Discusses relevance of core social work principles to medicine and how they are introduced…

  10. Doctoral Clinical Geropsychology Training in a Primary Care Setting

    ERIC Educational Resources Information Center

    Zweig, Richard A.; Siegel, Lawrence; Hahn, Steven; Kuslansky, Gail; Byrne, Kathy; Fyffe, Denise; Passman, Vicki; Stewart, Douglas; Hinrichsen, Gregory

    2005-01-01

    Most older adults diagnosed with a mental disorder receive treatment in primary care settings that lack personnel skilled in geropsychological diagnosis and treatment. The Ferkauf Older Adult Program of Yeshiva University endeavors to bridge this gap by providing training in geriatric psychology, through coursework and diverse clinical practica,…

  11. How Do Physicians Teach Empathy in the Primary Care Setting?

    ERIC Educational Resources Information Center

    Shapiro, Johanna

    2002-01-01

    Explored how primary care clinician-teachers actually attempt to convey empathy to medical students and residents. Found that they stress the centrality of role modeling in teaching, and most used debriefing strategies as well as both learner- and patient-centered approaches in instructing learners about empathy. (EV)

  12. Identifying Primary Care Skills and Competencies in Opioid Risk Management

    ERIC Educational Resources Information Center

    Chiauzzi, Emil; Trudeau, Kimberlee J.; Zacharoff, Kevin; Bond, Kathleen

    2011-01-01

    Introduction: Primary care physicians (PCPs) treat a high proportion of chronic pain patients but often lack training about how to assess and address issues associated with prescribing opioids when they are an appropriate component of therapy. The result may be that they may avoid treating these patients, which can lead to an undertreatment of…

  13. Evaluation of Health Educator Consults in Primary Care

    ERIC Educational Resources Information Center

    Maher, Stacia; Lopez, Patricia; McKee, M. Diane; Deen, Darwin; Fornari, Alice; Fletcher, Jason; Blank, Arthur

    2010-01-01

    Purpose: The paper aims to evaluate a primary care obesity prevention intervention, targeting low-income minority parents in the USA. The first objective is to describe the barriers to behavior change experienced by families. The second objective is to understand the types of strategies that were used by the health educator to empower families to…

  14. Suicide Attempts among Depressed Adolescents in Primary Care

    ERIC Educational Resources Information Center

    Fordwood, Samantha R.; Asarnow, Joan R.; Huizar, Diana P.; Reise, Steven P.

    2007-01-01

    Although depression is strongly associated with suicide attempts and suicide deaths, most depressed youth do not make an attempt, indicating the need to identify additional risk factors. We examined suicide attempts among 451 depressed primary care patients, 13 to 21 years of age. In bivariate analyses, youth classified as suicide attempters…

  15. Prioritizing Threats to Patient Safety in Rural Primary Care

    ERIC Educational Resources Information Center

    Singh, Ranjit; Singh, Ashok; Servoss, Timothy J.; Singh, Gurdev

    2007-01-01

    Context: Rural primary care is a complex environment in which multiple patient safety challenges can arise. To make progress in improving safety with limited resources, each practice needs to identify those safety problems that pose the greatest threat to patients and focus efforts on these. Purpose: To describe and field-test a novel approach to…

  16. The role of primary care providers in managing falls.

    PubMed

    Demons, Jamehl L; Duncan, Pamela W

    2014-01-01

    Falls threaten the ability of older adults to live independently in the community. Fortunately, national and state organizations have created tools that allow primary care providers to easily assess fall risk, and small changes in practice patterns can provide patients with the resources necessary to prevent falls, thus helping to reverse a costly, deadly epidemic. PMID:25237872

  17. Organizational culture, job satisfaction, and clinician turnover in primary care.

    PubMed

    Hall, Charles B; Brazil, Kevin; Wakefield, Dorothy; Lerer, Trudy; Tennen, Howard

    2010-04-01

    The purpose of this study is to examine how organizational culture and job satisfaction affect clinician turnover in primary care pediatric practices. One hundred thirty clinicians from 36 primary care pediatric practices completed the Primary Care Organizational Questionnaire (PCOQ), which evaluates interactions among members of the practice and job-related attributes measuring 8 organizational factors, along with a separate 3-item instrument measuring job satisfaction. Random effects logistic models were used to assess the associations between job satisfaction, the organizational factors from the PCOQ, and clinician turnover over the subsequent year. All 8 measured organizational factors from the PCOQ, particularly perceived effectiveness, were associated with job satisfaction. Five of the 8 organizational factors were also associated with clinician turnover. The effects of the organizational factors on turnover were substantially reduced in a model that included job satisfaction; only 1 organizational factor, communication between clinicians and nonclinicians, remained significant (P = .05). This suggests that organizational culture affects subsequent clinician turnover primarily through its effect on job satisfaction. Organizational culture, in particular perceived effectiveness and communication, affects job satisfaction, which in turn affects clinician turnover in primary care pediatric practices. Strategies to improve job satisfaction through changes in organizational culture could potentially reduce clinician turnover. PMID:23804066

  18. Depression Treatment Preferences in Older Primary Care Patients

    ERIC Educational Resources Information Center

    Gum, Amber M.; Arean, Patricia A.; Hunkeler, Enid; Tang, Lingqi; Katon, Wayne; Hitchcock, Polly; Steffens, David C.; Dickens, Jeanne; Unutzer, Jurgen

    2006-01-01

    Purpose: For depressed older primary care patients, this study aimed to examine (a) characteristics associated with depression treatment preferences; (b) predictors of receiving preferred treatment; and (c) whether receiving preferred treatment predicted satisfaction and depression outcomes. Design and Methods: Data are from 1,602 depressed older…

  19. Doing More in Pediatric Primary Care: The Healthy Steps Model

    ERIC Educational Resources Information Center

    Kaplan-Sanoff, Margot

    2007-01-01

    Pediatric primary care provides an enormous window of opportunity to offer families information and support on their child's social-emotional well-being and on their growth as a family in a nonstigmatizing environment. With new technology, such as the Internet, and advances in the scientific study of early childhood development, parents face an…

  20. Providing primary health care with non-physicians.

    PubMed

    Chen, P C

    1984-04-01

    The definition of primary health care is basically the same, but the wide variety of concepts as to the form and type of worker required is largely due to variations in economic, demographic, socio-cultural and political factors. Whatever form it takes, in many parts of the developing world, it is increasingly clear that primary health care must be provided by non-physicians. The reasons for this trend are compelling, yet it is surprisingly opposed by the medical profession in many a developing country. Nonetheless, numerous field trials are being conducted in a variety of situations in several countries around the world. Non-physician primary health care workers vary from medical assistants and nurse practitioners to aide-level workers called village mobilizers, village volunteers, village aides and a variety of other names. The functions, limitations and training of such workers will need to be defined, so that an optimal combination of skills, knowledge and attitudes best suited to produce the desired effect on local health problems may be attained. The supervision of such workers by the physician and other health professionals will need to be developed in the spirit of the health team. An example of the use of non-physicians in providing primary health care in Sarawak is outlined.

  1. Primary health care trading companies for sustainable development.

    PubMed

    Soeters, R; Nzala, S

    1994-01-01

    A programme of comprehensive primary health care in Zambia has been accompanied by the emergence of autonomous, non-profit trading and production companies that sell health-related goods to communities and health institutions and find markets for locally produced good.

  2. Education for primary health care: accommodating the new realities.

    PubMed

    Ritchie, J E

    1994-01-01

    The didactic, authoritarian model in which learners are lectured by teachers cannot meet the needs of people intending to work in health systems where equity, self-reliance, community participation and intersectoral collaboration are the watchwords. The author discusses how the education of health professionals for roles in primary health care should be conducted. PMID:8018277

  3. [Easily implemented cognitive behaviour techniques in primary care (part 2)].

    PubMed

    Ibáñez-Tarín, C; Manzanera-Escartí, R

    2014-01-01

    Cognitive behavioural therapy has shown to be very effective for treating the vast majority of mental health disorders. In this second part of the article, we continue commenting on those techniques that can be easily used in the Primary Care setting. PMID:24210520

  4. Primary health care trading companies for sustainable development.

    PubMed

    Soeters, R; Nzala, S

    1994-01-01

    A programme of comprehensive primary health care in Zambia has been accompanied by the emergence of autonomous, non-profit trading and production companies that sell health-related goods to communities and health institutions and find markets for locally produced good. PMID:8141978

  5. The Experience of Working with Refugees: Counsellors in Primary Care

    ERIC Educational Resources Information Center

    Century, Gillian; Leavey, Gerard; Payne, Helen

    2007-01-01

    The provision of counselling services for refugee and asylum-seeking patients is relatively new in the UK and their complex needs may present considerable challenges within primary care, where access to specialist support resources is often limited. As far as we know, no previous research has attempted to look at the experiences of the counsellors…

  6. Stopping the tsunami of stress in primary care.

    PubMed

    Pearson, Tamera

    2015-12-12

    This article provides an overview of the psychoneuroimmunologic impact of stress on illness along with a review of mind/body therapies to counteract the effects of stress. Primary care providers are encouraged to promote stress reduction and translate evidence into practice by recommending mind/body therapies. PMID:26566130

  7. Barriers to Cancer Screening by Rural Appalachian Primary Care Providers

    ERIC Educational Resources Information Center

    Shell, Renee; Tudiver, Fred

    2004-01-01

    Rural Appalachia has significantly higher overall cancer mortality compared with national rates, and lack of cancer screening is believed to be one of the contributing factors. Reducing the cancer disparity in this region must include strategies to address suboptimal cancer screening practices by rural Appalachian primary care providers (PCPs). To…

  8. The management of new primary care organizations: an international perspective.

    PubMed

    Meads, Geoffrey; Wild, Andrea; Griffiths, Frances; Iwami, Michiyo; Moore, Phillipa

    2006-08-01

    Management practice arising from parallel policies for modernizing health systems is examined across a purposive sample of 16 countries. In each, novel organizational developments in primary care are a defining feature of the proposed future direction. Semistructured interviews with national leaders in primary care policy development and local service implementation indicate that management strategies, which effectively address the organized resistance of medical professions to modernizing policies, have these four consistent characteristics: extended community and patient participation models; national frameworks for interprofessional education and representation; mechanisms for multiple funding and accountabilities; and the diversification of non-governmental organizations and their roles. The research, based on a two-year fieldwork programme, indicates that at the meso-level of management planning and practice, there is a considerable potential for exchange and transferable learning between previously unconnected countries. The effectiveness of management strategies abroad, for example, in contexts where for the first time alternative but comparable new primary care organizations are exercising responsibilities for local resource utilization, may be understood through the application of stakeholder analyses, such as those employed to promote parity of relationships in NHS primary care trusts.

  9. Primary health care in Turkey: a passing fashion?

    PubMed

    Tatar, M; Tatar, F

    1997-09-01

    The Alma-Ata Declaration has long been regarded as a watershed in the health policy arena. The global goal of the World Health Organization, 'Health for All by the Year 2000' through primary health care, has attracted many countries both in the developed and the developing world and commitments to this end have been made at every level. However, albeit this consensus on the paper, a common and explicit definition of the concept has not been reached yet. This paper aims at discussing various definitions of primary health care that emerged after the Declaration and also presenting a case study from Turkey, a country that advocates primary health care in her recent health policy reform attempts. After setting the conceptual framework for discussion the Turkish case is presented by using research carried out among Turkish policy-makers at different levels of the State apparatus. It has been concluded that application of primary health care principles as defined in the broad definition of the concept requires major changes or rather shake-ups in Turkey. These areas are outlined briefly at the end of the paper. PMID:10173403

  10. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Primary care case management services. 440.168 Section 440.168 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.168...

  11. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Primary care case management services. 440.168 Section 440.168 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.168...

  12. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Primary care case management services. 440.168 Section 440.168 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.168...

  13. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Primary care case management services. 440.168 Section 440.168 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.168...

  14. Integrated Modular Teaching of Human Biology for Primary Care Practitioners

    ERIC Educational Resources Information Center

    Glasgow, Michael S.

    1977-01-01

    Describes the use of integrated modular teaching of the human biology component of the Health Associate Program at Johns Hopkins University, where the goal is to develop an understanding of the sciences as applied to primary care. Discussion covers the module sequence, the human biology faculty, goals of the human biology faculty, laboratory…

  15. Learner Preferences of Primary Care Physicians in Continuing Medical Education.

    ERIC Educational Resources Information Center

    Christensen, Linda M.; And Others

    1985-01-01

    Primary care physicians were surveyed regarding their preference for lecture, hands-on, and problem-based learning sessions. Analyses found no significant relationship between individual learning style as determined by the instrument used and instructional preferences. The discussion examines potential reasons for these findings. (CT)

  16. Technology Mediated Information Sharing (Monitor Sharing) in Primary Care Encounters

    ERIC Educational Resources Information Center

    Asan, Onur

    2013-01-01

    The aim of this dissertation study was to identify and describe the use of electronic health records (EHRs) for information sharing between patients and clinicians in primary-care encounters and to understand work system factors influencing information sharing. Ultimately, this will promote better design of EHR technologies and effective training…

  17. Dissociative Spectrum Disorders in the Primary Care Setting.

    PubMed

    Elmore, James L.

    2000-04-01

    Dissociative disorders have a lifetime prevalence of about 10%. Dissociative symptoms may occur in acute stress disorder, posttraumatic stress disorder, somatization disorder, substance abuse, trance and possession trance, Ganser's syndrome, and dissociative identity disorder, as well as in mood disorders, psychoses, and personality disorders. Dissociative symptoms and disorders are observed frequently among patients attending our rural South Carolina community mental health center. Given the prevalence of mental illness in primary care settings and the diagnostic difficulties encountered with dissociative disorders, such illness may be undiagnosed or misdiagnosed in primary care settings. We developed an intervention model that may be applicable to primary care settings or helpful to primary care physicians. Key points of the intervention are identification of dissociative symptoms, patient and family education, review of the origin of the symptoms as a method of coping with trauma, and supportive reinforcement of cognitive and relaxation skills during follow-up visits. Symptom recognition, Education of the family, Learning new skills, and Follow-up may be remembered by the mnemonic device SELF. We present several cases to illustrate dissociative symptoms and our intervention. Physicians and other professionals using the 4 steps and behavioral approaches will be able to better recognize and triage patients with dissociative symptoms. Behaviors previously thought to be secondary to psychosis or personality disorders may be seen in a new frame of reference, strengthening the therapeutic alliance while reducing distress and acting-out behaviors.

  18. Integration of mental health into primary care in Kenya.

    PubMed

    Jenkins, Rachel; Kiima, David; Njenga, Frank; Okonji, Marx; Kingora, James; Kathuku, Dammas; Lock, Sarah

    2010-06-01

    Integration of mental health into primary care is essential in Kenya, where there are only 75 psychiatrists for 38 million population, of whom 21 are in the universities and 28 in private practice. A partnership between the Ministry of Health, the Kenya Psychiatric Association and the World Health Organization (WHO) Collaborating Centre, Institute of Psychiatry, Kings College London was funded by Nuffield Foundation to train 3,000 of the 5,000 primary health care staff in the public health system across Kenya, using a sustainable general health system approach. The content of training was closely aligned to the generic tasks of the health workers. The training delivery was integrated into the normal national training delivery system, and accompanied by capacity building courses for district and provincial level staff to encourage the inclusion of mental health in the district and provincial annual operational plans, and to promote the coordination and supervision of mental health services in primary care by district psychiatric nurses and district public health nurses. The project trained 41 trainers, who have so far trained 1671 primary care staff, achieving a mean change in knowledge score of 42% to 77%. Qualitative observations of subsequent clinical practice have demonstrated improvements in assessment, diagnosis, management, record keeping, medicine supply, intersectoral liaison and public education. Around 200 supervisors (psychiatrists, psychiatric nurses and district public health nurses) have also been trained. The project experience may be useful for other countries also wishing to conduct similar sustainable training and supervision programmes. PMID:20671901

  19. Innovation sustainability in challenging health-care contexts: embedding clinically led change in routine practice

    PubMed Central

    Martin, Graham P; Weaver, Simon; Currie, Graeme; Finn, Rachael; McDonald, Ruth

    2012-01-01

    The need for organizational innovation as a means of improving health-care quality and containing costs is widely recognized, but while a growing body of research has improved knowledge of implementation, very little has considered the challenges involved in sustaining change – especially organizational change led ‘bottom-up’ by frontline clinicians. This study addresses this lacuna, taking a longitudinal, qualitative case-study approach to understanding the paths to sustainability of four organizational innovations. It highlights the importance of the interaction between organizational context, nature of the innovation and strategies deployed in achieving sustainability. It discusses how positional influence of service leads, complexity of innovation, networks of support, embedding in existing systems, and proactive responses to changing circumstances can interact to sustain change. In the absence of cast-iron evidence of effectiveness, wider notions of value may be successfully invoked to sustain innovation. Sustainability requires continuing effort through time, rather than representing a final state to be achieved. Our study offers new insights into the process of sustainability of organizational change, and elucidates the complement of strategies needed to make bottom-up change last in challenging contexts replete with competing priorities. PMID:23554445

  20. Innovation sustainability in challenging health-care contexts: embedding clinically led change in routine practice.

    PubMed

    Martin, Graham P; Weaver, Simon; Currie, Graeme; Finn, Rachael; McDonald, Ruth

    2012-11-01

    The need for organizational innovation as a means of improving health-care quality and containing costs is widely recognized, but while a growing body of research has improved knowledge of implementation, very little has considered the challenges involved in sustaining change - especially organizational change led 'bottom-up' by frontline clinicians. This study addresses this lacuna, taking a longitudinal, qualitative case-study approach to understanding the paths to sustainability of four organizational innovations. It highlights the importance of the interaction between organizational context, nature of the innovation and strategies deployed in achieving sustainability. It discusses how positional influence of service leads, complexity of innovation, networks of support, embedding in existing systems, and proactive responses to changing circumstances can interact to sustain change. In the absence of cast-iron evidence of effectiveness, wider notions of value may be successfully invoked to sustain innovation. Sustainability requires continuing effort through time, rather than representing a final state to be achieved. Our study offers new insights into the process of sustainability of organizational change, and elucidates the complement of strategies needed to make bottom-up change last in challenging contexts replete with competing priorities.

  1. The Complexity of Primary Care Psychology: Theoretical Foundations.

    PubMed

    Smit, E H; Derksen, J J L

    2015-07-01

    How does primary care psychology deal with organized complexity? Has it escaped Newtonian science? Has it, as Weaver (1991) suggests, found a way to 'manage problems with many interrelated factors that cannot be dealt by statistical techniques'? Computer simulations and mathematical models in psychology are ongoing positive developments in the study of complex systems. However, the theoretical development of complex systems in psychology lags behind these advances. In this article we use complexity science to develop a theory on experienced complexity in the daily practice of primary care psychologists. We briefly answer the ontological question of what we see (from the perspective of primary care psychology) as reality, the epistemological question of what we can know, the methodological question of how to act, and the ethical question of what is good care. Following our empirical study, we conclude that complexity science can describe the experienced complexity of the psychologist and offer room for personalized client-centered care. Complexity science is slowly filling the gap between the dominant reductionist theory and complex daily practice. PMID:26058336

  2. The Complexity of Primary Care Psychology: Theoretical Foundations.

    PubMed

    Smit, E H; Derksen, J J L

    2015-07-01

    How does primary care psychology deal with organized complexity? Has it escaped Newtonian science? Has it, as Weaver (1991) suggests, found a way to 'manage problems with many interrelated factors that cannot be dealt by statistical techniques'? Computer simulations and mathematical models in psychology are ongoing positive developments in the study of complex systems. However, the theoretical development of complex systems in psychology lags behind these advances. In this article we use complexity science to develop a theory on experienced complexity in the daily practice of primary care psychologists. We briefly answer the ontological question of what we see (from the perspective of primary care psychology) as reality, the epistemological question of what we can know, the methodological question of how to act, and the ethical question of what is good care. Following our empirical study, we conclude that complexity science can describe the experienced complexity of the psychologist and offer room for personalized client-centered care. Complexity science is slowly filling the gap between the dominant reductionist theory and complex daily practice.

  3. Handheld optical coherence tomography scanner for primary care diagnostics.

    PubMed

    Jung, Woonggyu; Kim, Jeehyun; Jeon, Mansik; Chaney, Eric J; Stewart, Charles N; Boppart, Stephen A

    2011-03-01

    The goal of this study is to develop an advanced point-of-care diagnostic instrument for use in a primary care office using handheld optical coherence tomography (OCT). This system has the potential to enable earlier detection of diseases and accurate image-based diagnostics. Our system was designed to be compact, portable, user-friendly, and fast, making it well suited for the primary care office setting. The unique feature of our system is a versatile handheld OCT imaging scanner which consists of a pair of computer-controlled galvanometer-mounted mirrors, interchangeable lens mounts, and miniaturized video camera. This handheld scanner has the capability to guide the physician in real time for finding suspicious regions to be imaged by OCT. In order to evaluate the performance and use of the handheld OCT scanner, the anterior chamber of a rat eye and in vivo human retina, cornea, skin, and tympanic membrane were imaged. Based on this feasibility study, we believe that this new type of handheld OCT device and system has the potential to be an efficient point-of-care imaging tool in primary care medicine. PMID:21134801

  4. Primary Care Providers' Perceptions of Home Diabetes Telemedicine Care in the IDEATel Project

    ERIC Educational Resources Information Center

    Tudiver, Fred; Wolff, L. Thomas; Morin, Philip C.; Teresi, Jeanne; Palmas, Walter; Starren, Justin; Shea, Steven; Weinstock, Ruth S.

    2007-01-01

    Context: Few telemedicine projects have systematically examined provider satisfaction and attitudes. Purpose: To determine the acceptability and perceived impact on primary care providers' (PCP) practices of a randomized clinical trial of the use of telemedicine to electronically deliver health care services to Medicare patients with diabetes in…

  5. [Nursing students and mental health education in primary care].

    PubMed

    Miyai, Fernanda Tiemi; Barros, Sônia; Cortes, Jandro Moraes

    2014-03-01

    The University of Sao Paulo School of Nursing (EEUSP) went through a period of transition from undergraduate syllabus between the years 2009 and 2010. This change was made to integrate basic and clinical cycles and to reduce fragmentation of the disciplines. The mental health nursing education was included in many modules including the primary care. This qualitative study aimed to identify how the service offered to people with mental illness was performed by 20 undergraduate students in the context of primary care and how they were prepared. Data collection was conducted through semi-structured interviews, in August 2012, in EEUSP After thematic analysis, we separated in categories: Teaching-learning process, Basic Health Unit and Mental health-illness process. The socially constructed conception of madness added to the problems related to academic training may result in lack of preparation in nursing mental health care. PMID:24930278

  6. [Primary health care: challenges for implementation in Latin America].

    PubMed

    Giraldo Osorio, Alexandra; Vélez Álvarez, Consuelo

    2013-01-01

    A development process, marked by the re-appearance of the primary health care as the core of health systems, has emerged in Latin America. Governments have made a commitment to renew this strategy as the basis of their health systems. However, these health systems are mainly faced with re-introducing equity values, and there are common challenges such as providing the health systems with trained human resources in sufficient numbers, overcoming the fragmentation/segmentation of the systems, ensuring financial sustainability, improving governance, quality of care and information systems, expanding coverage, preparing to face the consequences of an aging population, the changing epidemiological profile, and increase in the response capacity of the public health system. This article is intended to provide a comprehensive view of the progress and challenges of the inclusion of primary care health systems in Latin American countries. PMID:23490062

  7. Metals and Disease: A Global Primary Health Care Perspective

    PubMed Central

    Mamtani, Ravinder; Stern, Penny; Dawood, Ismail; Cheema, Sohaila

    2011-01-01

    Metals are an important and essential part of our daily lives. Their ubiquitous presence and use has not been without significant consequences. Both industrial and nonindustrial exposures to metals are characterized by a variety of acute and chronic ailments. Underreporting of illnesses related to occupational and environmental exposures to chemicals including metals is of concern and presents a serious challenge. Many primary care workers rarely consider occupational and environmental exposures to chemicals in their clinical evaluation. Their knowledge and training in the evaluation of health problems related to such exposures is inadequate. This paper presents documented research findings from various studies that have examined the relationship between metal exposures and their adverse health effects both in developing and developed countries. Further, it provides some guidance on essential elements of a basic occupational and environmental evaluation to health care workers in primary care situations. PMID:22007209

  8. Cancer Risk Assessment for the Primary Care Physician

    PubMed Central

    Korde, Larissa A.; Gadalla, Shahinaz M.

    2009-01-01

    Summary Cancer is the second leading cause of death in the United States. Cancer risk assessment can be divided into two major categories: assessment of familial or genetic risk and assessment of environmental factors that may be causally related to cancer. Identification of individuals with a suspected heritable cancer syndrome can lead to additional evaluation and to interventions that can substantially decrease cancer risk. Special attention should also be paid to potentially modifiable cancer risk factors in the course of advising primary care patients regarding a healthy lifestyle. Clinical guidelines targeting both genetic and modifiable cancer risk factors are available, and can facilitate applying these health care principles in the primary care setting. PMID:19616151

  9. It Is Time to Integrate Abortion Into Primary Care

    PubMed Central

    2013-01-01

    The Roe v Wade decision made safe abortion available but did not change the reality that more than 1 million women face an unwanted pregnancy every year. Forty years after Roe v Wade, the procedure is not accessible to many US women. The politics of abortion have led to a plethora of laws that create enormous barriers to abortion access, particularly for young, rural, and low-income women. Family medicine physicians and advanced practice clinicians are qualified to provide abortion care. To realize the promise of Roe v Wade, first-trimester abortion must be integrated into primary care and public health professionals and advocates must work to remove barriers to the provision of abortion within primary care settings. PMID:23153160

  10. A tele-otology course for primary care providers.

    PubMed

    Eikelboom, Robert H; Weber, Susanna; Atlas, Marcus D; Dinh, Quan; Mbao, Mathew N; Gallop, Mark A

    2003-01-01

    The shortage of otolaryngologists and the high incidence of ear disease in remote areas are major problems in Australia. We have developed a multimedia course for primary care providers that incorporates material about ear anatomy and physiology, ear disease, video-otoscopy and telemedicine software. The computer-based course was followed by a practical one-day course. A multiple-choice test was given to participants before and at the end of the course and a form was used to record feedback. The course was conducted with 30 aboriginal health workers. The participants were able to obtain images of reasonable to good quality after a short period of training. There was an average improvement of about 25% in the test scores, and the feedback regarding the course was extremely positive. The CD-ROM and the Website provide a valuable resource to assist primary care providers in their care of patients with ear disorders. PMID:14728751

  11. [Primary health care in Italy: from medical behaviour to teamwork].

    PubMed

    Mazzeo, Maria Concetta

    2012-01-01

    Primary health care represents an essential area in relation to health protection: its purposes are, on the one hand, health promotion, on the other hand the possibility to resort only if necessary to hospital care. In the novel National Collective Agreement, new teamwork forms of organization are introduced; for example, the obligatory Territorial Functional Aggregation: an organizational Unit which general practitioners and general paediatricians join to. The article by Scala et al. (see page 17), about an experience of primary health care, focuses the necessity to plan new organizational forms of work for teams oriented to realize efficient and effective answers to population needs: the phases of the activities in équipe are analysed, lingering on lights and shadows of the team.

  12. [Primary health care: challenges for implementation in Latin America].

    PubMed

    Giraldo Osorio, Alexandra; Vélez Álvarez, Consuelo

    2013-01-01

    A development process, marked by the re-appearance of the primary health care as the core of health systems, has emerged in Latin America. Governments have made a commitment to renew this strategy as the basis of their health systems. However, these health systems are mainly faced with re-introducing equity values, and there are common challenges such as providing the health systems with trained human resources in sufficient numbers, overcoming the fragmentation/segmentation of the systems, ensuring financial sustainability, improving governance, quality of care and information systems, expanding coverage, preparing to face the consequences of an aging population, the changing epidemiological profile, and increase in the response capacity of the public health system. This article is intended to provide a comprehensive view of the progress and challenges of the inclusion of primary care health systems in Latin American countries.

  13. Expanding the boundaries of primary care for elderly people.

    PubMed

    Netting, F E; Williams, F G

    2000-11-01

    This article reports the results of a qualitative evaluation of the Generalist Physician Initiative, designed to enhance the care of older people provided by primary care physicians in nine demonstration projects around the country. A theme entitled "Pushing the Comfort Zone" examines activities in which physicians engage before collaboration: selecting elderly patients, "opening cans of worms," recognizing patient and family expectations, and going outside the comfort zone. A second theme called "Linking with Collaborators" reveals activities in which physicians engage as they collaborate: teaming, using intervention agents as eyes and ears, communicating, and tracking patients. Findings indicate that social workers are logical collaborators with primary care physicians as contemporary practice is expanding to be more holistic.

  14. Recommendations for undergraduate training in the primary care sector--position paper of the GMA-Primary Care Committee.

    PubMed

    Huenges, Bert; Gulich, Markus; Böhme, Klaus; Fehr, Folkert; Streitlein-Böhme, Irmgard; Rüttermann, Viktor; Baum, Erika; Niebling, Wilhelm-Bernhard; Rusche, Herbert

    2014-01-01

    During their studies to become medical professionals, all students are obliged to become familiar with various aspects of primary care. The aim is to provide all students with a high quality training which ensures the best possible cooperation across all sectors of the medical system. Primary care comprises the primary use of the medical service by an unfiltered set of patients as well as continued patient care--including home-care. This position paper was developed together with representatives of the German Society of University Teachers of General Practice (GHA), the German Society for Ambulatory General Paediatrics (DGAAP), the German Society of General Practice and Family Medicine (DEGAM) and the German Society for Internal Medicine (DGIM). It includes recommendations for teaching in the field of primary care in four different types of internships such as preclinical work experience ("Hospitation"), 4-week clinical traineeships of a casual nature ("Famulatur") and 2-week courses of structured and assessed clinical training ("Blockpraktikum") as well as a broad-based 4-month elective clinical placement in the final year (known as a practical year, "PJ"). The recommendations encompass structural and process criteria for internships in different general practices. In addition, for the first time recommendations for teaching on campus--in the fields of general medicine, paediatrics, numerous cross-sectional areas and other clinical fields, but also for clinical skills training--are set down here. In this position paper the intention is to demonstrate the possible ways in which more aspects of primary care could be integrated into undergraduate medical training.

  15. Recommendations for Undergraduate Training in the Primary Care Sector – Position Paper of the GMA-Primary Care Committee

    PubMed Central

    Huenges, Bert; Gulich, Markus; Böhme, Klaus; Fehr, Folkert; Streitlein-Böhme, Irmgard; Rüttermann, Viktor; Baum, Erika; Niebling, Wilhelm-Bernhard; Rusche, Herbert

    2014-01-01

    During their studies to become medical professionals, all students are obliged to become familiar with various aspects of primary care. The aim is to provide all students with a high quality training which ensures the best possible cooperation across all sectors of the medical system. Primary care comprises the primary use of the medical service by an unfiltered set of patients as well as continued patient care – including home-care. This position paper was developed together with representatives of the German Society of University Teachers of General Practice (GHA), the German Society for Ambulatory General Paediatrics (DGAAP), the German Society of General Practice and Family Medicine (DEGAM) and the German Society for Internal Medicine (DGIM). It includes recommendations for teaching in the field of primary care in four different types of internships such as preclinical work experience (“Hospitation”), 4-week clinical traineeships of a casual nature (“Famulatur”) and 2-week courses of structured and assessed clinical training (“Blockpraktikum”) as well as a broad-based 4-month elective clinical placement in the final year (known as a practical year, “PJ”). The recommendations encompass structural and process criteria for internships in different general practices. In addition, for the first time recommendations for teaching on campus – in the fields of general medicine, paediatrics, numerous cross-sectional areas and other clinical fields, but also for clinical skills training – are set down here. In this position paper the intention is to demonstrate the possible ways in which more aspects of primary care could be integrated into undergraduate medical training. PMID:25228937

  16. Rainbow of Chaos: A study into the Theory and Practice of Integrated Primary Care

    PubMed Central

    Valentijn, Pim P.

    2016-01-01

    This thesis aimed to contribute to a better understanding of what integrated primary care is, and how it can be achieved by focussing on the collaboration processes that underlie the development of integrated primary care. The first part of this thesis operationalized the concept of integrated care from a primary care perspective. The second part of this thesis described the collaboration mechanisms among integrated care projects that were part of a national integrated primary care study in The Netherlands. PMID:27616959

  17. Financial incentives influencing the integration of mental health care and primary care.

    PubMed

    Goldberg, R J

    1999-08-01

    Psychiatric problems are common in general medical practice and strongly influence utilization of medical care. Although several studies have demonstrated the positive clinical and financial impact of psychiatric interventions for medical patients, historic and economic forces have tended to maintain the separation of the primary health and mental health components of care. The author discusses the financial incentives that influence the success or failure of initiatives to integrate mental health care and primary care. Most models for financing care that use fee-for-service, carve-out, or capitated arrangements have done little to encourage collaborative treatment planning and coordination of care or have created conditions that work against such integration. True financial incentives for integration of psychiatric and primary health care are provided only by a shared-risk model of capitation-a model that has long existed in staff-model health maintenance organizations. This model increases motivation to lower overall utilization of care, improve patients' overall health status, and search for more effective models of care.

  18. Primary Care Patients’ Perspectives of Barriers and Enablers of Primary Prevention and Health Promotion—A Meta-Ethnographic Synthesis

    PubMed Central

    Moreno-Peral, Patricia; Conejo-Cerón, Sonia; Fernández, Ana; Berenguera, Anna; Martínez-Andrés, María; Pons-Vigués, Mariona; Motrico, Emma; Rodríguez-Martín, Beatriz; Bellón, Juan A.; Rubio-Valera, Maria

    2015-01-01

    Background Primary care (PC) patients have difficulties in committing to and incorporating primary prevention and health promotion (PP&HP) activities into their long-term care. We aimed to re-interpret, for the first time, qualitative findings regarding factors affecting PC patients' acceptance of PP&HP activities. Methods and Findings A meta-ethnographic synthesis was generated following electronic and manual searches that retrieved 29 articles. Papers were reviewed and translated to produce a re-interpretation of the extracted concepts. The factors affecting PC patients' receptiveness to PP&HP activities were framed in a four-level ecological model (intrapersonal, interpersonal, institutional and environment and society). Intrapersonal factors (patients' beliefs/attitudes, knowledge, skills, self-concept, motivation and resources) were the most numerous, with almost 25 different factors. Public health education to modify erroneous beliefs and values regarding PP&HP could encourage a transition to healthier lifestyles. Health care professionals' abilities to communicate and involve patients in the decision-making process can act as facilitators. Biopsychosocial training (with emphasis on communication skills) for health professionals must start with undergraduates. Increased consultation time, the use of reminders, follow-up visits and tools for communicating risk and motivating patients could be applied at the intrapersonal level. Collaborative care involving other health professionals (nutritionists or psychotherapists) and family and community stakeholders (teachers or gym trainers) was important in developing healthier habits. Patients also cited barriers related to the built environment and socioeconomic difficulties that highlighted the need for policies promoting social justice and equity. Encouraging PP&HP using social marketing strategies and regulating media to control its impact on health were also cited. Only the perspectives of PC patients in the

  19. Determinants for the effectiveness of implementing an occupational therapy intervention in routine dementia care

    PubMed Central

    2013-01-01

    Background A multifaceted implementation (MFI) strategy was used to implement an evidence-based occupational therapy program for people with dementia (COTiD program). This strategy was successful in increasing the number of referrals, but not in improving occupational therapists’ (OTs) adherence. Therefore, a process evaluation was conducted to identify factors that influenced the effectiveness of the MFI strategy. Methods A mixed-method approach of qualitative and quantitative research was used to evaluate the implementation process. The MFI strategy as planned and as executed were reported and evaluated based on the framework of Hulscher et al. (2003; 2006). Data on OTs attitudes and expected barriers were collected at baseline from 94 OTs using a 19-item questionnaire. Data on the experiences were collected after finishing the implementation using focus groups with OTs and telephone interviews with physicians and managers. For quantitative data, frequencies and correlations were calculated and qualitative data were analyzed using inductive content analysis. Results The implementation strategy as executed had a stronger focus than planned on increasing OTs promotional skills due to an initial lack of referrals. This resulted in less attention for increasing OTs’ skills in using the COTiD program as initially intended. At baseline, OTs had a positive attitude toward the program, however, 75% did not feel experienced enough and only 14.3% felt competent in using the program. Focus groups and interviews revealed various determinants that influenced implementation. Most managers were positive about the program. However, the degree of operational support of managers for OTs regarding the implementation was not always adequate. Managers stated that a well-defined place for occupational therapy within the dementia care network was lacking although this was perceived necessary for successful implementation. Several physicians perceived psychosocial interventions not

  20. Primary Care Research Team Assessment (PCRTA): development and evaluation.

    PubMed Central

    Carter, Yvonne H.; Shaw, Sara; Macfarlane, Fraser

    2002-01-01

    BACKGROUND: Since the early 1990s the United Kingdom (UK) Department of Health has explicitly promoted a research and development (R&D) strategy for the National Health Service (NHS). General practitioners (GPs) and other members of the primary care team are in a unique position to undertake research activity that will complement and inform the research undertaken by basic scientists and hospital-based colleagues and lead directly to a better evidence base for decision making by primary care professionals. Opportunities to engage in R&D in primary care are growing and the scope for those wishing to become involved is finally widening. Infrastructure funding for research-active practices and the establishment of a range of support networks have helped to improve the research capacity and blur some of the boundaries between academic departments and clinical practice. This is leading to a supportive environment for primary care research. There is thus a need to develop and validate nationally accepted quality standards and accreditation of performance to ensure that funders, collaborators and primary care professionals can deliver high quality primary care research. Several strategies have been described in national policy documents in order to achieve an improvement in teaching and clinical care, as well as enhancing research capacity in primary care. The development of both research practices and primary care research networks has been recognised as having an important contribution to make in enabling health professionals to devote more protected time to undertake research methods training and to undertake research in a service setting. The recognition and development of primary care research has also brought with it an emphasis on quality and standards, including an approach to the new research governance framework. PRIMARY CARE RESEARCH TEAM ASSESSMENT: In 1998, the NHS Executive South and West, and later the London Research and Development Directorate, provided