Primary Health Care Research & Development最新文献

{"title":"‘The biggest car crash in NHS history’: the media portrayal of GP pay before and after the introduction of the Health and Social Care Bill 2011","authors":"Adam Balkham, S. Alderson","doi":"10.1017/S1463423616000359","DOIUrl":"https://doi.org/10.1017/S1463423616000359","url":null,"abstract":"Background The introduction of the Health and Social Care Bill (2011) changed the role of GPs to include commissioning of health services. Aim This study aimed to identify any differences in the media portrayal of GPs before and after the introduction of the Bill. Methods We retrospectively searched four British newspapers over the period 2009–2013 using the media database Nexis. In order to directly compare the findings of the study with the work of Tanner et al., articles relating to GP pay were analysed using thematic analysis. Themes were identified and each article was scored to determine whether it portrayed GPs positively or negatively. Results GPs were portrayed slightly less negatively after the introduction of the Bill. The theme of ‘high salaries’ persisted despite reference to ‘pay freezes’. References to decreased trust in the patient–doctor relationship appeared after the introduction of the Bill. Conclusion Negative portrayal of GP pay has continued and a lack of trust in GPs has started to be portrayed. This trend may exacerbate the low morale amongst the profession and difficulties in recruiting and retaining GPs.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75904255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity services planning framework for interprofessional primary care organizations","authors":"P. Brauer, D. Royall, J. Dwyer, A. M. Edwards, T. Hussey, N. Kates, Heidi J. Smith, Ross Kirkconnell","doi":"10.1017/S1463423616000372","DOIUrl":"https://doi.org/10.1017/S1463423616000372","url":null,"abstract":"Aim We report on a formative project to develop an organization-level planning framework for obesity prevention and management services. Background It is common when developing new services to first develop a logic model outlining expected outcomes and key processes. This can be onerous for single primary care organizations, especially for complex conditions like obesity. Methods The initial draft was developed by the research team, based on results from provider and patient focus groups in one large Family Health Team (FHT) in Ontario. This draft was reviewed and activities prioritized by 20 FHTs using a moderated electronic consensus process. A national panel then reviewed the draft. Findings Providers identified five main target groups: pregnancy to 2, 3–12, 13–18, 18+ years at health risk, and 18+ with complex care needs. Desired outcomes were identified and activities were prioritized under categories: raising awareness (eg, providing information and resources on weight-health), identification and initial management (eg, wellness care), follow-up management (eg, group programs), expanded services (eg, availability of team services), and practice initiatives (eg, interprofessional education). Overall, there was strong support for raising awareness by providing information on the weight-health connection and on community services. There was also strong support for growth assessment in pediatric care. In adults, there was strong support for wellness care/health check visits and episodic care to identify people for interventions, for group programs, and for additional provider education. Conclusions Joint development by different teams proved useful for consensus on outcomes and for ensuring relevancy across practices. While priorities will vary depending on local context, the basic descriptions of care processes were endorsed by reviewers. Key next steps are to trial the use of the framework and for further implementation studies to find optimally effective approaches for obesity prevention and management across the lifespan.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78385470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Providers’ perceptions of barriers and facilitators to disclosure of alcohol use by women veterans","authors":"Traci H. Abraham, E. Lewis, K. Drummond, C. Timko, Michael A. Cucciare","doi":"10.1017/S1463423616000384","DOIUrl":"https://doi.org/10.1017/S1463423616000384","url":null,"abstract":"Aim To better understand barriers and facilitators that hinder or help women veterans discuss their alcohol use with providers in primary care in order to better identify problematic drinking and enhance provider–patient communication about harmful drinking. Background Women presenting to primary care may be less likely than men to disclose potentially harmful alcohol use. No studies have qualitatively examined the perspectives of primary care providers about factors that affect accurate disclosure of alcohol use by women veterans during routine clinic visits. Methods Providers (n=14) were recruited from primary care at two veterans Administration Women’s Health Clinics in California, United States. An open-ended interview guide was developed from domains of the consolidated framework for implementation science. Interviews elicited primary care providers’ perspectives on barriers and facilitators to women veterans’ (who may or may not be using alcohol in harmful ways) disclosure of alcohol use during routine clinic visits. Interview data were analyzed deductively using a combination of template analysis and matrix analysis. Findings Participants reported six barriers and five facilitators that they perceived affect women veteran’s decision to accurately disclose alcohol use during screenings and openness to discussing harmful drinking with a primary care provider. The most commonly described barriers to disclosure were stigma, shame, and discomfort, and co-occuring mental health concerns, while building strong therapeutic relationships and using probes to ‘dig deeper’ were most often described as facilitators. Findings from this study may enhance provider–patient discussions about alcohol use and help primary care providers to better identify problematic drinking among women veterans, ultimately improving patient outcomes.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86081753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of the patient evaluation scale (PES) for primary health care in Nigeria","authors":"D. Ogaji, Sally J. Giles, G. Daker-White, P. Bower","doi":"10.1017/S1463423616000244","DOIUrl":"https://doi.org/10.1017/S1463423616000244","url":null,"abstract":"Background Questionnaires developed for patient evaluation of the quality of primary care are often focussed on primary care systems in developed countries. Aim To report the development and validation of the patient evaluation scale (PES) designed for use in the Nigerian primary health care context. Methods An iterative process was used to develop and validate the questionnaire using patients attending 28 primary health centres across eight states in Nigeria. The development involved literature review, patient interviews, expert reviews, cognitive testing with patients and waves of quantitative cross-sectional surveys. The questionnaire’s content validity, internal structures, acceptability, reliability and construct validity are reported. Findings The full and shortened version of PES with 27 and 18 items, respectively, were developed through these process. The low item non-response from the serial cross-sectional surveys depicts questionnaire’s acceptability among the local population. PES-short form (SF) has Cronbach’s α of 0.87 and three domains (codenamed ‘facility’, ‘organisation’ and ‘health care’) with Cronbach’s αs of 0.78, 0.79 and 0.81, respectively. Items in the multi-dimensional questionnaire demonstrated adequate convergent and discriminant properties. PES-SF scores show significant positive correlation with scores of the full PES and also discriminated population groups in support of a priori hypotheses. Conclusion The PES and PES-SF contain items that are relevant to the needs of patients in Nigeria. The good measurement properties of the questionnaire demonstrates its potential usefulness for patient-focussed quality improvement activities in Nigeria. There is still need to translate these questionnaires into major languages in Nigeria and assess their validity against external quality criteria.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91185033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a community-based diabetes self-management education (DSME) program in a rural agricultural setting","authors":"E. Paz-Pacheco, M. Sandoval, G. J. R. Ardena, E. Paterno, N. Juban, F. Lantion-Ang, C. Jimeno, Perpetua C Patal, Joseph Bongon","doi":"10.1017/S1463423616000335","DOIUrl":"https://doi.org/10.1017/S1463423616000335","url":null,"abstract":"Introduction The purpose of this study is to assess the effectiveness of diabetes self-management education (DSME) in a rural agricultural town. Methods In this prospective, education-intervention trial, 85 adults with type 2 diabetes mellitus from villages randomly assigned to DSME and 70 from villages assigned to standard care participated. The DSME group underwent a curriculum delivered by peer educators; those in the standard group received usual advice. Outcome measures were anthropometric, biochemical, health behaviors, and medication use data taken at baseline then after three and six months. Results DSME group had a lower median A1C after three and six months. After six months, there was a 0.5% median A1C reduction in DSME group and a 0.25% increase in the standard group. There were more participants in DSME group with A1C ⩽7.0% after three and six months. By the third month, there were more participants in DSME group performing foot examination. Conclusion DSME in this rural agricultural town improved glycemic control and promoted foot examination.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86641025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare personnel’s experiences using video consultation in primary healthcare in rural areas","authors":"Annette M. Johansson, I. Lindberg, S. Söderberg","doi":"10.1017/S1463423616000347","DOIUrl":"https://doi.org/10.1017/S1463423616000347","url":null,"abstract":"Background Patients living in rural areas often need to travel long distances for access to specialist care. To increase access to specialist care, video consultation between patients in primary healthcare and specialist care has been used. In order for this new method to be developed and used to the fullest, it is important to understand healthcare personnel’s experiences with this intervention. Objective The aim of this study was to describe healthcare personnel’s experiences using video consultation in their work in primary healthcare. Method A mixed methods design was used, and the data were analysed using qualitative and quantitative analysis methods. Interviews were conducted with eight general practitioners and one district nurse, all of whom had conducted a video consultation with a patient and a specialist physician or a cardiac specialist nurse. After each video consultation, the participants completed a consultation report/questionnaire. Results Healthcare personnel considered video consultation to provide quicker access to specialist care for the patient, and greater security when the video consultation encounter was conducted at their own primary healthcare centre. They considered video consultation an opportunity to provide education and for the patients to ask questions. Conclusion Video consultation is a satisfactory tool for healthcare personnel, and the technology is a new, useful method, especially for the district nurses. Further, video consultation is an opportunity for healthcare personnel to learn. However, for it to work as an accepted method, the technology must function well and be user friendly. It must also be clear that it is beneficial for the patients and the healthcare personnel.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86547525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Swedish National Diabetes Register in clinical practice and evaluation in primary health care","authors":"Ing-Marie Hallgren Elfgren, E. Grodzinsky, E. Törnvall","doi":"10.1017/S1463423616000098","DOIUrl":"https://doi.org/10.1017/S1463423616000098","url":null,"abstract":"Aim The purpose of this project is to describe the use of the Swedish National Diabetes Register (NDR) in clinical practice in a Swedish county and to specifically monitor the diabetes care routines at two separate primary health-care centres (PHCC) with a special focus on older patients. Background According to Swedish law, all health-care units have to maintain a system for quality evaluation and improvement. As the NDR holds the most important quality indicators, implementation of the NDR in primary care was carried out by an implementation project in 2002–2005. Methods Initially, a digital questionnaire about NDR routines was sent to all PHCC. Statistics about hemoglobin adult 1c (HbA1c) and blood pressure (BP) was presented for the diabetes teams at two centres who were also interviewed. The responses became the basis for a focus group interview with both teams together, with data subject to content analysis. Findings The study showed that reporting to the NDR has become a compulsory routine in primary care. The diabetes nurse specialist was responsible for the practical management of the register and used the NDR for continuous monitoring of the patients. Most centres used the NDR’s statistics for evaluation and analyses annually. The diabetes nurse adapted the visits to the patient’s wishes and general condition. Only in terms of target values for HbA1c and BP did they accept slightly higher values for the older patients. Since the NDR was implemented, the registration rate has remained at 75% and has not increased. The reason given was that patients with diabetes living in nursing homes are checked up by the municipal nurse who does not use the NDR. However, the risk of omitting older patients in the NDR could be considerably decreased if data could be transferred from the electronic patient record.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78951865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training mid-level health cadres to improve health service delivery in rural Bangladesh","authors":"L. Rawal, Kawkab Mahmud, S. M. S. Islam, R. Mahumud, Md Nuruzaman, S. Ahmed","doi":"10.1017/S1463423616000104","DOIUrl":"https://doi.org/10.1017/S1463423616000104","url":null,"abstract":"Introduction In recent years, the government of Bangladesh has encouraged private sector involvement in producing mid-level health cadres including Medical Assistants (MAs). The number of MAs produced has increased significantly. We assessed students’ characteristics, educational services, competencies and perceived attitudes towards health service delivery in rural areas. Methods We used a mixed method approach using quantitative (questionnaire survey) and qualitative (key informant interviews and roundtable discussion) methods. Altogether, five public schools with 238 students and 30 private schools with 732 students were included. Statistical analyses were performed using STATA v-12. Qualitative data were analyzed thematically. Findings The majority of the students in both public (66%) and private medical assistant training schools (MATS) (61%) were from rural backgrounds. They spent the majority of their time in classroom learning (public 45% versus private 42%) and the written essay exam was the common form of a students’ performance assessment. Compared with students of public MATS, students of private MATS were more confident in different aspects of educational areas, including managing emerging health needs (P<0.001); evidence-based practice (P=0.002); critical thinking and problem solving (P=0.02), and use of IT/computer skills (P<0.001). Students were aware of not having adequate facilities in rural areas (public 71%, private 65%), but they perceived working in rural areas will offer several benefits, including use of learnt skills; friendly rural people; and opportunities for real-life problem solving, etc. Conclusion This study provides a current picture of MATS students’ characteristics, educational services, competencies and perception towards working in rural areas. The MA students in both private and public sectors showed a greater level of willingness to serve in rural health facilities. The results are promising to improve health service delivery, particularly in rural and hard-to-reach areas of Bangladesh.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research &amp; Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85728798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Health Care Research & Development: Official Journal of the European Forum for Primary Care","authors":"P. Groenewegen, J. De Maeseneer, S. Kendall","doi":"10.1017/S1463423616000116","DOIUrl":"https://doi.org/10.1017/S1463423616000116","url":null,"abstract":"Announced in August 2015, Primary Health Care Research & Development (PHCRD) is now the Official Journal of the European Forum for Primary Care (EFPC). Both PHCRD and EFPC are delighted with this connection. The EFPC aims to strengthen the position of primary care in European countries. As the health needs of the population of Europe are changing, strong primary care for all is increasingly important. As a result of an ageing population and an increase in multi-morbidity, health care has to move from an emphasis on (single) diseases to person-centred care (De Maeseneer and Boeckxstaens, 2012). The health problems of people do not follow the narrowly defined classifications of health-care professionals. People need – and increasingly expect – collaboration both within primary care and between the boundaries of primary care, the secondary health-care sector and social care. As such, primary care is in a position to offer more integrated care described as putting the patient’s perspective at the heart of any discussion about health care. Achieving integrated care requires those involved with planning and providing services to ‘impose the patient perspective as the organising principle of service delivery’ (Lloyd and Wait, 2005: 7). This could be seen as a guiding principle of strong primary care. However, strong primary care is not something that comes about by itself (Groenewegen et al., 2002). It is not the ‘natural state’ of health-care systems but requires regulation, for example, in making primary care responsible for a defined population and the first point of contact for people with health problems. Therefore, the EFPC provides advocacy for strong primary care. Advocacy is needed at different levels, ranging from local and regional, where primary care practice is shaped, to national, where governments and civil society organizations (patient organizations, professional groups) work towards optimal regulation, and also at European level. The European level is important, even though the organization of health-care systems is not the remit of the EU. In the end, the EU is built on economic principles and consumer choice. When we realize how important a part of the economy the health sector is (on average 10% of gross national product, paying the salaries of again ~10%of the workforce), it will come as no surprise that EU advice on the member states’ economy (eg through the country-specific recommendations of the European Semester) often relates to the health-care sector. European advocacy is therefore at the same time strongly needed but difficult to achieve – for example, exactly where should such advocacy be directed? However, within the EU there is also a need for information and inputs to gain legitimacy and to test ideas and propositions. As an advocate for strong primary care, the EFPC has a track record in responding to relevant consultations, organized by the EU. It is often difficult to assess the impact of these actions, but they place","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research &amp; Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90109996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of UK’s Minor Ailments Scheme and US’s retail clinic model: a narrative review","authors":"A. Win","doi":"10.1017/S1463423616000086","DOIUrl":"https://doi.org/10.1017/S1463423616000086","url":null,"abstract":"There is a raising demand for unscheduled care in the United Kingdom. Minor Ailments Schemes (MAS) were introduced to reduce the burden of minor ailments on higher cost settings such as general practices and emergency departments. The number of visits for minor ailments at GPs often declined following the implementation of MAS. Retail clinics in America employ nurse practitioners (NPs) and physician assistants (PAs) who can diagnose and treat minor illness, and minor injuries. Similar to the retail clinics, MAS can merge with walk-in centres. PAs and NPs can take over some primary care workload from pharmacists to prevent the pharmacists from being overwhelmed with all their current duties. MAS can also initiate the development of telehealth service to accommodate the home-bound patients. MAS must continue to change and evolve to meet the current and future demands of health care.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research &amp; Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86672171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}