The Lancet. Primary care最新文献

{"title":"How major international development organisations operationalise primary health care: a thematic content analysis of strategy documents.","authors":"Luke N Allen, Erica Barbazza, Tova Tampe, Suraya Dalil, Shamsuzzoha Syed, Faraz Khalid","doi":"10.1016/j.lanprc.2025.100014","DOIUrl":"10.1016/j.lanprc.2025.100014","url":null,"abstract":"<p><p>Despite consensus around the need to prioritise primary health care (PHC), misaligned interpretations of this concept have real-world consequences for implementation. Here, we analysed how 30 major international development organisations operationalise PHC in their corporate strategy documents through thematic content analysis. The findings reveal that despite high-level endorsement for PHC, fewer than half of the reviewed documents explicitly mentioned PHC. Among those that did, PHC was conceptualised in varying ways: as a service delivery platform, level of care, bundle of interventions, or whole-of-society approach to health. From these conceptualisations, three different interpretations of PHC emerged-namely, the intended whole-of-society approach to health, strong or high-quality primary care, and selective or basic primary care. Integral components to PHC, including empowered people and communities and multisectoral action, were largely absent. These findings highlight the opportunities and urgency for improved alignment across international organisations to support a consistent approach aligned with the original vision of PHC.</p>","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"1 1","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot implementation of intermittent preventive treatment with dihydroartemisinin-piperaquine to prevent adverse birth outcomes in Papua, Indonesia: a mixed-method evaluation.","authors":"Firdaus Hafidz, Freis Candrawati, Jenna Hoyt, Enny Kenangalem, James Dodd, Maia Lesosky, Ida Safitri Laksanawati, Reynold Ubra, Minerva Simatupang, Feiko O Ter Kuile, Eve Worrall, Jeanne Rini Poespoprodjo, Jenny Hill","doi":"10.1016/j.lanprc.2025.100011","DOIUrl":"https://doi.org/10.1016/j.lanprc.2025.100011","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;A previous trial showed that intermittent preventive treatment with dihydroartemisinin-piperaquine (IPTp-DP) was more effective than the current policy of single screening and treatment in preventing malaria during pregnancy in Papua, Indonesia. The STOPMiP-2 study evaluated the Ministry of Health pilot implementation of IPTp-DP through routine antenatal care in Papua.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A mixed-method evaluation was conducted in ten primary health-care facilities in the Mimika district in Papua, Indonesia from June 8, 2022, to Dec 27, 2023. Pregnant women aged 15-49 years who were HIV negative (when status known), in their second or third trimester of pregnancy, and provided written informed consent were eligible. IPTp-DP delivery effectiveness (3-day doses of three tablets [ie, nine tablets] with the first dose by directly observed therapy during antenatal care) and adherence (completion of all nine tablets, ascertained by pill count) were coprimary outcomes. Analyses were done in the modified intention-to-treat (mITT) population (defined for delivery effectiveness as all women who completed exit interviews, and for treatment adherence as all women who had a home visit). The mITT population excluded women with fever or malaria infection, those with a positive malaria test, or those who received IPTp-DP outside the designated timeframe (ie, less than 4 weeks between courses). We explored predictors of delivery effectiveness and adherence using multivariable logistic regression, and used qualitative data to provide explanatory insights. We used routine health information to assess monthly coverage by facility. This study was registered at ClinicalTrials.gov (NCT05294406) and is now complete.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;From June 8, 2022, to Dec 27, 2023, we enrolled 1420 pregnant women in exit interviews, of whom 1366 had data available and were eligible for the effectiveness analysis. 490 women were visited at home, of whom 484 had data available and were eligible for the adherence analysis. 556 (41%) of 1366 women had effective delivery of IPTp-DP, and among those with available data, 437 (90%) of 484 had full adherence. Predictors of full effective delivery versus partial or non-effective delivery were older maternal age (≥35 years &lt;i&gt;vs&lt;/i&gt; 20-34 years: adjusted odds ratio 1·26 [95% CI 1·04-1·51], p=0·017), having a lower level of education (no education or primary education &lt;i&gt;vs&lt;/i&gt; diploma or university: 2·01 [1·08-3·75], p=0·028), being in the second trimester (&lt;i&gt;vs&lt;/i&gt; third trimester; 3·13 [2·11-4·63], p&lt;0·0001), had previous IPTp-DP (&lt;i&gt;vs&lt;/i&gt; no previous IPTp-DP: 4·30 [3·07-6·01], p&lt;0·0001), and not having health insurance (&lt;i&gt;vs&lt;/i&gt; health insurance: 1·33 [1·09-1·63], p=0·0044). No difference was seen by younger age (age 15-19 years), middle or high school education, ethnicity, marital status, previous malaria test within past 28 days, and location. Predictors of adherence were being","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"1 1","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144987009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing, identifying, and managing sepsis in the community: research and clinical priorities.","authors":"Kristina E Rudd, Adrienne G Randolph, Derek C Angus, Michael Bauer, Christopher F Chesley, Michael R Filbin, Grace Jenq, Jordan A Kempker, Adam C Levine, Phillip Levy, Flavia R Machado, Nicholas M Mohr, Robert Quinn, Kathryn Rowan, Manu Shankar-Hari, Fatima Sheikh, Patrycja Sleboda, Jeb S Teichman, Thierry Calandra, Hallie C Prescott","doi":"10.1016/j.lanprc.2025.100010","DOIUrl":"10.1016/j.lanprc.2025.100010","url":null,"abstract":"<p><p>Sepsis, defined as life-threatening acute organ dysfunction due to infection, is generally considered a hospital-based issue. However, sepsis usually begins in the community, where knowledge of sepsis is scarce, diagnosis is difficult, and resources vary. Community-based interventions might offer the best opportunity for prevention, prompt diagnosis, and improved outcomes. In this Viewpoint, we address current gaps and limitations in understanding of sepsis in the community and outline research priorities, clinical priorities, and existing initiatives across four domains: mitigation (ie, reduction of population-based sepsis risk), monitoring (ie, screening for sepsis in individuals at high risk of sepsis), measurement (ie, identification of sepsis in the community), and management (ie, treatment of sepsis in the community). We propose a pathway to improve the care of individuals with, or at risk of, sepsis in the community and delineate the next steps to advance the field.</p>","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}