The primary health care system(PHCS)is the portal and basis for the national health delivery system.There are a number of elements which comprise the PHCS,but the system cannot be established and developed without the...The primary health care system(PHCS)is the portal and basis for the national health delivery system.There are a number of elements which comprise the PHCS,but the system cannot be established and developed without the support of“three essential elements,”including general practitioners(GPs),health insurance,and government health investment.Through comparative analysis of the“three essential elements”of the PHCS between California in the US and Guangdong in China,this article indicates that there are three important aspects in developing a PHCS in China,as follows:training qualified GPs;establishing a diversified health insurance system to strengthen the policy connections between health insurance and the PHCS thereby increasing government health investment;and broadening health financing channels.展开更多
This review article is aimed at describing the primary healthcare system of Pakistan and its challenges in the face of epidemic of type 2 diabetes, focusing particularly on the middle-aged population of rural area of ...This review article is aimed at describing the primary healthcare system of Pakistan and its challenges in the face of epidemic of type 2 diabetes, focusing particularly on the middle-aged population of rural area of Pakistan. The main concern in Pakistan is that its middle-aged population is facing the onslaught of obesity and overweight due to lack of physical activity. In addition unhealthy eating habits making it more difficult for this population to control their weight. All these factors are contributing to a high risk of type 2 diabetes for the population of Pakistan. This article provides insight into the primary health care system of Pakistan and highlights its deficiencies by identifying that its primary healthcare system has a poor utilization of health care services, the poor accessibility to health system and poor management of diabetes by the healthcare system, gender disparity and inequity in the health care system. The primary objective of this study is to provide an overview of self-management of diabetes among the middle-aged population of Pakistan and to identify the overall deficiencies in the primary healthcare system, its delivery and access to the system, barriers to self-management of diabetes and quality of life in that region.展开更多
Teaching strategies can be considered as techniques that are constructed to be used with the objective of promoting teaching and learning in the classroom, so that the teacher is considered a mentor, as he is the one ...Teaching strategies can be considered as techniques that are constructed to be used with the objective of promoting teaching and learning in the classroom, so that the teacher is considered a mentor, as he is the one who selects, analyzes, studies, organizes, builds and proposes the most classic tools to facilitate the learning process [1]. This study is an experience report related to the construction of an educational product that consists of the elaboration of pedagogical strategies, characterized by five didactic sequences in the perspective of collaborating with teaching-learning processes in lato sensu graduate courses. The themes that are part of the didactic sequences were built based on the results obtained in scientific research carried out during the development of the strict sensu postgraduate course in Teaching in Health and Technology, which involved: the work of coordinators who work in the field of health management in Primary Care, situations that challenge the management of Primary Care and the potentialities of work in the management of Primary Care. The didactic sequences have fun teaching strategies that provide meaningful learning for a future qualified professional performance. These sequences involve the use of active methodologies and the use of digital tools. The educational product developed seeks to promote benefits that can collaborate with the improvement of Primary Care Management and teaching-learning processes in the training of health professionals. Therefore, the pedagogical strategies, as well as its entire construction process, were developed through the collaboration of professors of the Health and Society discipline at the State University of Health Sciences of Alagoas (UNCISAL), seeking to make it qualify for effective construction of knowledge and that promote its wide use in the academic environment.展开更多
The standardized hypertension management provided by primary health care workers is an important part of China's recent health care reform efforts. Investigating 5,116 hypertensive patients from a cross-sectional sur...The standardized hypertension management provided by primary health care workers is an important part of China's recent health care reform efforts. Investigating 5,116 hypertensive patients from a cross-sectional survey conducted by the Chinese Center for Disease Control and Prevention in 2012, this study found that adherence to standardized hypertension management is associated with positive effects on hypertension- related knowledge, healthy lifestyle behavior, antihypertensive medical treatments, and blood pressure control. It will be necessary to provide primary health care workers with sufficient training and reasonable incentives to ensure the implementation and effectiveness of hypertension management.展开更多
<b><span style="font-family:Verdana;">Background: </span></b></span><span><span><span style="font-family:""><span style="font-family:Ver...<b><span style="font-family:Verdana;">Background: </span></b></span><span><span><span style="font-family:""><span style="font-family:Verdana;">Ultrasound remains a tool of much importance in maternity care with midwives regarded as key health professionals when it comes to care of pregnant mothers. There is however limited study on the knowledge and skills gaps of midwives in conducting obstetric ultrasonography screening. The purpose of this study was to assess the specific obstetric ultrasonography knowledge and skills gaps among midwives based in primary health care facilities. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">A cross-sectional study employing both qualitative and quantitative method was conducted between July and August 2019 with 274 midwives. A structured questionnaire was used to collect data while Focus group discussion and Key Informants Interview were used to collect qualitative data. Descriptive statistics were used to summarize the data test associations between variables while the qualitative data were used to compliment the questionnaire data in eliciting more information on the gaps. </span><b><span style="font-family:Verdana;">Findings: </span></b><span style="font-family:Verdana;">Almost all (94.5%) the midwives had never been trained on any basic obstetric ultrasound while six of those that had been trained in early stages by the project</span><b> </b><span style="font-family:Verdana;">lacked equipment to practice the acquired skills. More than three quarters of the respondents opined that they wished to provide personalized care services to mothers/clients seeking Antenatal Care Services (ANC) in </span><span style="font-family:Verdana;">their community at a fee while only 13.9% had knowledge that obstetric</span><span style="font-family:Verdana;"> screening should be done before 24 weeks gestation. Four out of ten</span><b> </b><span style="font-family:Verdana;">of the respondents scored themselves a one (1) on the level of confidence they have using an ultrasound machines or technology. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">There still remains </span><span style="font-family:Verdana;">a huge gap as far as training of midwives on basic ultrasound screening is</span><span style="font-family:Verdana;"> concerned. The lack of basic obstetric ultrasound screening skills is a barrier </span><span style="font-family:Verdana;">to rolling out Point of Care Ultrasound (POCUS) screening services. Howev</span><span style="font-family:Verdana;">er, midwives are motivated and willing to learn basic ultrasonography skills to further the objectives of Universal Health Coverage (UHC). Concerted efforts should be made to train midwives on basic obstetric ultrasonography skills in addition to availing mobile/hand held ultrasound technology in Primary Health facilities for them to apply the transferred skills. A sustainable business model to enable mothers continuously afford the services is critical as well.展开更多
Patient-centered care has over the past decades, been recognized worldwide as an important component of the health system giving a wider dimension to high-quality healthcare and service delivery. The impact on healthc...Patient-centered care has over the past decades, been recognized worldwide as an important component of the health system giving a wider dimension to high-quality healthcare and service delivery. The impact on healthcare and services to the patient is the nurses’ ability to create a friendly rapport with the patients. Yet, the majority in the rural Primary Health Care facilities are still facing many challenges in demonstrating patient-centeredness services to the community. Thus, the objective of this study is to explore and describe the factors influencing patient-centered care provision and nurses’ experience in Primary Health Care facilities. An exploratory qualitative approach with purposive sampling was used to gather data. Individual interviews with 35 nurses were conducted using a semi-structure interview guide question in the Primary Health Care settings in Nigeria. Each of the interviews with the nurses lasted for 25 minutes to one hour. All interviews were audio-taped, and transcribed verbatim using Microsoft Word. The transcripts were read and re-read, coded using NVivo version 12 software to organize the relevant information and categorized them into themes and sub-themes. Thematic analysis guided this study. The findings revealed three themes and sub-themes. The impact of environmental factors with two subthemes—suitable working environment and coordinated care;resources—shortage of staff and inadequate resources as sub-themes, and lastly, cultural sensitivity and religious influence—communication. Poor implementation of PCC strategies in most of the PHC facilities could lead to poor patient care and a lack of job satisfaction among nurses. This study identified that nurses have both negative and positive experience in providing patient-centered care health services. Providing patient-centered care in the Primary Health Care setting promotes the goal of achieving universal health coverage in Nigeria if the government would prioritize nurses’ pay, employ more staff, provide a conducive working environment, and opportunities for further training programs for nurses to enable and empower them with the necessary knowledge and skills. This, in turn, will translate into a range of outcomes that are socially valued, such as health responsiveness, health coverage and fairness.展开更多
Globally, patient-centered care has become the focus of the healthcare system. It is imperative to note that during a global pandemic crisis, patient-centered care principles seek to empower partnering approaches in P...Globally, patient-centered care has become the focus of the healthcare system. It is imperative to note that during a global pandemic crisis, patient-centered care principles seek to empower partnering approaches in Primary Health Care (PHC), and have recently gained prominence in nursing practice and applied nursing research. However, nurses are faced with challenges in achieving the desired results in the PHC system. Thus, the study aimed to explore the factors that influence PCC utilization in the PHC facilities in Nigeria. A qualitative exploratory-descriptive design was used for this study. Data collection was conducted with the nurses from PHC facilities through individual interviews. Data saturation was achieved with 35 participants from 30 PHC facilities in Osun State, Nigeria, using a purposive sampling technique. All interviews were audio-recorded, later transcribed verbatim, and analyzed using the thematic analysis approach. NVivo 12 software was used for data management. The results from this study were categorized into two factors: Organizational factors and individual factors. Six themes that emerged from the study include inadequate management support, insufficient opportunities for further training, work overload and time constraints, health personnel readiness to use PCC, dearth enthusiasm for change, and poor nurses’ Accountability. The study shows that nurses encountered diverse challenges in providing patient-centered care. To improve the quality of healthcare delivery in the PHC facilities, there is a need to reinforce adequate management support, education, continued training, and the internal motivation of nurses to achieve transformative health outcomes in the community.展开更多
Integration of Palliative Care into Primary Health Care will have a substantial amount of positive impact on Health Care in Nakuru County,Kenya.Consequently,all aspects of Palliative Care should be given to more than ...Integration of Palliative Care into Primary Health Care will have a substantial amount of positive impact on Health Care in Nakuru County,Kenya.Consequently,all aspects of Palliative Care should be given to more than 2/3 population that suffer from cancers and chronic illnesses which sometimes overflow to some acute conditions.While Palliative Care focuses on Holistic Care encompassing physical,psychological,social,and spiritual aspects to adults and children,Primary Health Care operates on the principles of equity,solidarity,universal access to services,multisectoral action,social justice,centralization,and community participation.Thus,there are similarities in Palliative Care and Primary Health Care putting into consideration that the latter is based on practical,scientifically sound and socially accepted methods and technology.It is affordable,universally accessible to individuals and families in the community.Universal Health Coverage ensures that all people and communities have access to promotive,preventive,curative,rehabilitative,and palliative health services they need,of sufficient quality to be effective while also ensuring that the use of these services does not expose the users to financial hardships.The 60%of the Nakuru County population are in need of Palliative Care services,but only about 20%access these services.They suffer from cancers,non-communicable diseases,dementia,and frailty.Geographical challenges,staff shortages,and lack of Palliative Care knowledge are the main barriers to provision of care.展开更多
This study aims to identify the actions performed by nurses of the Family Health Strategy with the pregnancy cycle of adolescents and analyze if the actions developed by these nurses are focused on risk prevention in ...This study aims to identify the actions performed by nurses of the Family Health Strategy with the pregnancy cycle of adolescents and analyze if the actions developed by these nurses are focused on risk prevention in pregnancy and childbirth. It is a qualitative and exploratory research in basic health units with 12 nurses. A semi-structured interview technique was applied, and the speeches were analyzed using content analysis. In the analysis of the results, it was identified two thematic categories in which it was noted that nurses during the prenatal make the reception of pregnant adolescents differently and conduct guidelines on examination, signs and symptoms of possible complications during the pregnancy and still emphasize the importance of educational activities as groups of pregnant women to be a chance of coexistence and exchange of experiences, doubts, and anxieties among themselves. It is concluded that the care provided by nurses is fundamental for the pregnant adolescents having prenatal with more quality.展开更多
Objectives: The goal of this project was to evaluate the quality of the accessibility of the adult population to services in Primary Health Care, with a view to contribute to the development of measures that will prop...Objectives: The goal of this project was to evaluate the quality of the accessibility of the adult population to services in Primary Health Care, with a view to contribute to the development of measures that will propose improvement in the offered assistance. Methods: This is a quantitative and evaluative study made in the municipality of Santa Cruz, State of Rio Grande do Norte, Brazil, with a sample of 180 people. The study was approved by the Ethics and Research Committee of the Federal University of Rio Grande do Norte under Opinion number 152/2012. Results: It was found that the adult population classified the quality of care from regular to good, showing an association with the waiting time, time spent from the unit to one’s house and the reception. Conclusions: It could be concluded that this study contributes to the development of strategies able to provide a full and equitable care to the adult population in the primary health care network, since this is the gateway to other levels of care, because it aims to promote adult health and prevent diseases.展开更多
Objective: To assess comprehensive care in the elderly population, as well as the quality of care in Primary Health Care. Methods: This is an exploratory descriptive study with a quantitative approach, conducted from ...Objective: To assess comprehensive care in the elderly population, as well as the quality of care in Primary Health Care. Methods: This is an exploratory descriptive study with a quantitative approach, conducted from July to December 2012, in the city of Santa Cruz, Rio Grande do Norte, Brazil. A sample of 130 subjects chosen by drawn was calculated, and data collection was performed at their homes. Results: There were interviewed 130 people, 92 (70.8%) women and 38 men (29.2%), with a minimum age of 60 and maximum of 96 years, with a mean of 72.8, median of 72.0 and a standard deviation of 8.3. Regarding the quality of care ratings of the PHC team, 48.5% (n = 63) of respondents stated this to be good, while 32.3% (n = 42) rated this as fair. Conclusions: In this perspective, one of the most appreciated meanings that were given to comprehensive care by health care professionals refers to holistic knowledge of each patient, resulting in the non-fragmentation of care. Thus, it is noticed that comprehensiveness has some weaknesses that need to be corrected, which shows the need for education and training of professionals assigned to primary health care services.展开更多
Objective: To study changes in lifestyle and biological risk markers in a 24-year follow-up study, and occurrences of cardiovascular diseases (CVD), cancer and total mortality from official registers. Design: A 24-yea...Objective: To study changes in lifestyle and biological risk markers in a 24-year follow-up study, and occurrences of cardiovascular diseases (CVD), cancer and total mortality from official registers. Design: A 24-year follow-up survey and register study of a cohort of men 33 - 42 years old, examined with a health profile at baseline. With the health profile based on lifestyle, biological risk markers, self-rated mental stress and mental health, the men were separated in different risk groups. Setting: Primary health care center of Habo in Sweden. Subjects: All 757 men, 33 - 42 years old, and living in the community of Habo in Sweden in 1985. Main Outcome Measures: Lifestyle, biological risk markers, morbidity from CVD and cancer, and total mortality. Results: Smoking and physical activity decreased during follow-up time while alcohol consumption increased. Biological risk markers, except diastolic blood pressure, deteriorated significantly with age. Based on three- lifestyle groups, 16 % of the men had a more favorable lifestyle and 19% had a less favorable life-style at follow-up compared with baseline. The men, who had been classified as high-risk, based on the health profile at baseline, had a significantly higher incidence of CVD and cancer in the register study compared to men in a low-risk group. The baseline non-participant group had a significantly higher incidence of CVD and a higher mortality compared to the low-risk group. Conclusion: A health profile with a combination of lifestyle factors and biological risk markers can already at the age of 33 - 42 years predict incidence of CVD and cancer on group level among men after 24 years.展开更多
Objective To explore the different modes and approaches of medical and preventive integration in current primary health care institutions in China.Methods Through literature analysis,field research,telephone interview...Objective To explore the different modes and approaches of medical and preventive integration in current primary health care institutions in China.Methods Through literature analysis,field research,telephone interviews,and other methods the implementation status was evaluated to systematically study the main experience and effect of implementing medical and preventive integration services in pilot areas.Results and Conclusion At present,there are three implementation modes of medical-prevention integration,namely,vertical mode based on the medical community,internal mode with optimized service process,and internal mode with great service capabilities.The three medical-prevention integration modes have their respective focuses,but they need to be further improved in terms of policy support,technical staffing,information system construction,and drug use.展开更多
Introduction: The involvement of undergraduate student at the beginning of their training in activities based on Primary Health Care (PHC), provides preventive and health promoting actions, and ensures the evaluation ...Introduction: The involvement of undergraduate student at the beginning of their training in activities based on Primary Health Care (PHC), provides preventive and health promoting actions, and ensures the evaluation of the vulnerability of communities and people. Objectives: To analyze the opinion of students and teachers of two medicine higher education institutions on the relevance of Primary Health Care in this course. METHODS: Students and teachers should be effectively enrolled in order for the study to be conducted, being chosen in a random manner and without interferences on the part of the researchers so that the work was as reliable as possible. A cross-sectional study was conducted with interviews structured in questionnaires about what they thought about PHC. To some students and teachers of the medical course of Valen?a and Grande Rio University (UNIGRANRIO). Before receiving the questionnaire, all interviewed signed a Free and Informed Consent Term, which included the objectives and methodology of the work. Results: 310 students and 51 teachers participated in the study, where 91.43% of the students and 100% of the teachers affirmed that primary care plays a fundamental role in medical education. 94.86% of students and 97.91% of teachers, claimed that the discipline allows a greater contact between undergraduates and community. When questioned about the encouragement that teachers give to students to pursue a career in PHC, 57.87% of the students and 70.83% of the professors said they lacked in such a stimulus. Conclusion: PHC is still very neglected by governmental policies, educational institutions and by the own teachers, that often, turn they attention only to tertiary medicine and, as a consequence, a discouragement of this area occur. Therefore, a higher PHC value is necessary, allowing a more humane look at the patient, valuing their feelings, anguishes and their pathological framework.展开更多
Purpose:The aim of this study was to examine the self-care practices and health-seeking behaviours of older adults in urban Indonesia.Methods:The cross-sectional study was performed from January to March 2014 in the T...Purpose:The aim of this study was to examine the self-care practices and health-seeking behaviours of older adults in urban Indonesia.Methods:The cross-sectional study was performed from January to March 2014 in the Tammua sub-district of Indonesia.At the time of the study,273 older adults resided in Tammua,and half of them(51.2%)participated in this study.Data collection was carried out including self-care practices,health literacy,self-efficacy and basic conditioning factors.Results:It was found that most respondents(124;88.6%)always ate various protein sources daily.However,many participants never limited consumption of sugar(55;39.3%)or salt(40;28.6%),and more than half of respondents(96;68.6%)did not regularly visit MHCs.Health status(p<0.05),health maintenance(p<0.01)and salt limitation(p<0.05)were all significantly associated with salt limitation.It was found that respondents with higher selfefficacy,those who did not want to get information,and those of younger ages are less likely to visit MHCs regularly.Conclusion:An understanding of self-care practices and self-efficacy is needed to improve health care in developing countries.High self-efficacy should be promoted along with adequate health literacy.Older persons should learn the importance of regular health examinations to promote health,prevent diseases,and slow the progress of chronic diseases.The number of respondents who never limit their sugar and salt intake was especially surprising.An intervention program should be developed to limit salt and sugar intake of Indonesian elderly and to motivate older persons to use primary health services.展开更多
Background Longevity,combined with a higher prevalence of obesity,particularly visceral obesity,has been associated with an increased risk of cardiovascular diseases.Insulin resistance(IR)is an important link between ...Background Longevity,combined with a higher prevalence of obesity,particularly visceral obesity,has been associated with an increased risk of cardiovascular diseases.Insulin resistance(IR)is an important link between visceral obesity and cardiovascular diseases.An important association has been found between sagittal abdominal diameter,visceral obesity and IR.The objective of this study is to evaluate sagittal abdominal diameter as a marker of visceral obesity and correlate it with IR in older primary health care patients.Methods A cross-sectional study was performed with 389 patients over 60 years of age(70.6±6.9),of whom 74%were female.Their clinical,anthropometric and metabolic profiles were assessed and their fasting serum insulin level was used to calculate the homeostasis model assessment insulin resistance(HOMA-IR).Sagittal abdominal diameter was measured in the supine position at the midpoint between the iliac crest and the last rib with abdominal calipers.Results Sagittal abdominal diameter was significantly correlated with anthropometric measures of general and visceral obesity and with HOMA-IR in both genders.There was no change in the association between sagittal abdominal diameter and HOMA-IR after adjusting for age,sex,diabetes and hypertension.Conclusion It is feasible to use sagittal abdominal diameter in older primary care patients as a tool to evaluate visceral obesity,which is an indicator of cardiovascular risk.展开更多
Background:Recruiting research participants from primary care in rural Appalachia is a major challenge and can be influenced by cultural characteristics,making it critically important to incorporate strategies of cult...Background:Recruiting research participants from primary care in rural Appalachia is a major challenge and can be influenced by cultural characteristics,making it critically important to incorporate strategies of cultural competence in the overall design of clinical research.Objectives:The purpose of this paper is to describe culturally competent strategies used for recruitment and data collection with a sample of adults with type 2 diabetes from primary care settings in Appalachia.Design:The Purnell model of cultural competence and relevant literature served as a framework for study design.Four overarching approaches informed the organization of recruitment strategies and development of the data collection plan.Procedures:The approaches included selection of research sites,establishing collaborations,sustaining collaborative relationships,and enhancing understanding of benefits of participation.Four recruitment sites were selected based on potential to enhance diversification of participants;multiple steps were included in each of the three remaining approaches to build relationships and gain participation.A study log was maintained to provide evaluation data.Results:Recruitment took 14 months and a sample of 102 subjects provided consent with 101 participants providing complete data.Demographics were representative of the region except that African American participation was higher(6.9%)compared to current north central Appalachia(3%).Over 72%of participants indicated they would be interested in participating in future studies.Conclusions:These findings emphasize the importance of employing strategies for cultural competence in study design.Use of concepts from the Purnell model led to enhanced representativeness and potential for subsequent generalizability.展开更多
The progressive aging of society has become a global concern, and is expected to lead to the development of effective, sustainable, person-centered, integrated community-based care systems. However, there is insuffici...The progressive aging of society has become a global concern, and is expected to lead to the development of effective, sustainable, person-centered, integrated community-based care systems. However, there is insufficient evidence regarding effective integrated community-based care. In particular, few studies have focused on social aspects of the community environment related to elderly health. This study aimed to consider social aspects as evaluation items, focusing particularly on social determinants from the perspective of community-dwelling people, to explore truly effective integrated community-based care to improve elderly health. The definition of social determinants means social cohesion in social and community contexts. A literature review of English articles published in peer-reviewed journals up to October 2019 was conducted using PubMed, MEDLINE, and CINAHL with the following search terms: “social cohesion,” “elderly health,” “mental health” and “community.” Identified articles were screened based on title and abstract, and selected articles were subjected to full-text assessment and critical review. All references cited in the selected articles were also reviewed. The following inclusion criteria were used: 1) studies targeting community-dwelling elderly people or community-dwelling people including elderly people as participants;2) studies with clear descriptions of social factors in the Methods section;and 3) studies with clear descriptions of health-related items in the Methods section. From the 21 articles analyzed, of which 9 articles defined social determinants as social cohesion in social and community context, 37 items were extracted as social aspects at the community level that reflect the perspective of residents. These items can be developed as evaluation items for community-based health care outcomes through consensus among community health care providers and further investigation.展开更多
Objective: To evaluate the essential attribute of Primary Health Care, longitudinal care, care directed at children from birth to two years old. Methods: This is a descriptive and exploratory study of evaluative chara...Objective: To evaluate the essential attribute of Primary Health Care, longitudinal care, care directed at children from birth to two years old. Methods: This is a descriptive and exploratory study of evaluative character and quantitative approach, conducted with parents/caregivers of 186 children, younger than two years old, patients of primary health care services in the city of Santa Cruz/RN, Brazil. For data collection, the instrument Primary Care Assessment Tools (PCA Tools) was used, and the results of the questions dealing with longitudinal attribute were evaluated. The data were stored and processed in Statistical Package for Social Sciences (SPSS). The study was approved by the Research Ethics Committee of the Health Sciences School of Trairí, under number 348896. Results: The mean age of children in months was 8.21;84.4% (n = 157) were assisted by the same doctor/nurse every time;in 81.7% (n = 152) of cases the doctor/nurse know the full medical history of the child;73.7% (n = 137) answered that the professional know their child more as a person than just as someone with a health problem;48.9% (n = 91) stated that the doctor/nurse do not know their family very well;86.6% (n = 161) reported finding the doctor/nurse understands what is saying or questioning;96.2 (n = 179) of respondents said the doctor/nurse answers the questions so that they understand;96.2% (n = 179) of the interviewed said they feel comfortable telling the concerns or problems of their child to the doctor/nurse;66.7% (n = 124) claimed that they would not change the service/doctor/nurse to another health service. Conclusion: It is concluded that the attribute was well rated by the mothers of children seen in primary health care services and that they can establish good communication and relationship with the health professionals who treat their children.展开更多
Objective To explore the current situation and problems of the pharmacy organization and pharmaceutical services in primary medical and health institutions so as to provide a reference for improving relevant policies....Objective To explore the current situation and problems of the pharmacy organization and pharmaceutical services in primary medical and health institutions so as to provide a reference for improving relevant policies.Methods Multi-stage stratified random sampling was used to collect questionnaires from primary medical and health institutions in 5 provinces,and 102 questionnaires were distributed.Then Excel 2016 and IBM SPSS 21.0 software were applied for descriptive statistical analysis,chi-square test and multiple response analysis.Results and Conclusion A total of 92 primary medical and health institutions participated in the survey,and 92 valid questionnaires were recovered.The survey shows that 54.1%of the institutions have established more than 8 pharmaceutical administration regulations.63.5%and 31.8%of the institutions have formulated pharmaceutical administration and pharmacotherapy team charters(or management systems).29.7%of institutions have pharmacy personnel in accordance with relevant regulations.The higher proportion of pharmacy services are prescription review and adjustment,medication guidance,collecting and reporting adverse reactions,medication errors and medication hazard information.Primary medical and health institutions still need to further improve their pharmaceutical administration system,organizational structure,pharmacy professional training and clinical pharmacy service.展开更多
文摘The primary health care system(PHCS)is the portal and basis for the national health delivery system.There are a number of elements which comprise the PHCS,but the system cannot be established and developed without the support of“three essential elements,”including general practitioners(GPs),health insurance,and government health investment.Through comparative analysis of the“three essential elements”of the PHCS between California in the US and Guangdong in China,this article indicates that there are three important aspects in developing a PHCS in China,as follows:training qualified GPs;establishing a diversified health insurance system to strengthen the policy connections between health insurance and the PHCS thereby increasing government health investment;and broadening health financing channels.
文摘This review article is aimed at describing the primary healthcare system of Pakistan and its challenges in the face of epidemic of type 2 diabetes, focusing particularly on the middle-aged population of rural area of Pakistan. The main concern in Pakistan is that its middle-aged population is facing the onslaught of obesity and overweight due to lack of physical activity. In addition unhealthy eating habits making it more difficult for this population to control their weight. All these factors are contributing to a high risk of type 2 diabetes for the population of Pakistan. This article provides insight into the primary health care system of Pakistan and highlights its deficiencies by identifying that its primary healthcare system has a poor utilization of health care services, the poor accessibility to health system and poor management of diabetes by the healthcare system, gender disparity and inequity in the health care system. The primary objective of this study is to provide an overview of self-management of diabetes among the middle-aged population of Pakistan and to identify the overall deficiencies in the primary healthcare system, its delivery and access to the system, barriers to self-management of diabetes and quality of life in that region.
文摘Teaching strategies can be considered as techniques that are constructed to be used with the objective of promoting teaching and learning in the classroom, so that the teacher is considered a mentor, as he is the one who selects, analyzes, studies, organizes, builds and proposes the most classic tools to facilitate the learning process [1]. This study is an experience report related to the construction of an educational product that consists of the elaboration of pedagogical strategies, characterized by five didactic sequences in the perspective of collaborating with teaching-learning processes in lato sensu graduate courses. The themes that are part of the didactic sequences were built based on the results obtained in scientific research carried out during the development of the strict sensu postgraduate course in Teaching in Health and Technology, which involved: the work of coordinators who work in the field of health management in Primary Care, situations that challenge the management of Primary Care and the potentialities of work in the management of Primary Care. The didactic sequences have fun teaching strategies that provide meaningful learning for a future qualified professional performance. These sequences involve the use of active methodologies and the use of digital tools. The educational product developed seeks to promote benefits that can collaborate with the improvement of Primary Care Management and teaching-learning processes in the training of health professionals. Therefore, the pedagogical strategies, as well as its entire construction process, were developed through the collaboration of professors of the Health and Society discipline at the State University of Health Sciences of Alagoas (UNCISAL), seeking to make it qualify for effective construction of knowledge and that promote its wide use in the academic environment.
文摘The standardized hypertension management provided by primary health care workers is an important part of China's recent health care reform efforts. Investigating 5,116 hypertensive patients from a cross-sectional survey conducted by the Chinese Center for Disease Control and Prevention in 2012, this study found that adherence to standardized hypertension management is associated with positive effects on hypertension- related knowledge, healthy lifestyle behavior, antihypertensive medical treatments, and blood pressure control. It will be necessary to provide primary health care workers with sufficient training and reasonable incentives to ensure the implementation and effectiveness of hypertension management.
文摘<b><span style="font-family:Verdana;">Background: </span></b></span><span><span><span style="font-family:""><span style="font-family:Verdana;">Ultrasound remains a tool of much importance in maternity care with midwives regarded as key health professionals when it comes to care of pregnant mothers. There is however limited study on the knowledge and skills gaps of midwives in conducting obstetric ultrasonography screening. The purpose of this study was to assess the specific obstetric ultrasonography knowledge and skills gaps among midwives based in primary health care facilities. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">A cross-sectional study employing both qualitative and quantitative method was conducted between July and August 2019 with 274 midwives. A structured questionnaire was used to collect data while Focus group discussion and Key Informants Interview were used to collect qualitative data. Descriptive statistics were used to summarize the data test associations between variables while the qualitative data were used to compliment the questionnaire data in eliciting more information on the gaps. </span><b><span style="font-family:Verdana;">Findings: </span></b><span style="font-family:Verdana;">Almost all (94.5%) the midwives had never been trained on any basic obstetric ultrasound while six of those that had been trained in early stages by the project</span><b> </b><span style="font-family:Verdana;">lacked equipment to practice the acquired skills. More than three quarters of the respondents opined that they wished to provide personalized care services to mothers/clients seeking Antenatal Care Services (ANC) in </span><span style="font-family:Verdana;">their community at a fee while only 13.9% had knowledge that obstetric</span><span style="font-family:Verdana;"> screening should be done before 24 weeks gestation. Four out of ten</span><b> </b><span style="font-family:Verdana;">of the respondents scored themselves a one (1) on the level of confidence they have using an ultrasound machines or technology. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">There still remains </span><span style="font-family:Verdana;">a huge gap as far as training of midwives on basic ultrasound screening is</span><span style="font-family:Verdana;"> concerned. The lack of basic obstetric ultrasound screening skills is a barrier </span><span style="font-family:Verdana;">to rolling out Point of Care Ultrasound (POCUS) screening services. Howev</span><span style="font-family:Verdana;">er, midwives are motivated and willing to learn basic ultrasonography skills to further the objectives of Universal Health Coverage (UHC). Concerted efforts should be made to train midwives on basic obstetric ultrasonography skills in addition to availing mobile/hand held ultrasound technology in Primary Health facilities for them to apply the transferred skills. A sustainable business model to enable mothers continuously afford the services is critical as well.
文摘Patient-centered care has over the past decades, been recognized worldwide as an important component of the health system giving a wider dimension to high-quality healthcare and service delivery. The impact on healthcare and services to the patient is the nurses’ ability to create a friendly rapport with the patients. Yet, the majority in the rural Primary Health Care facilities are still facing many challenges in demonstrating patient-centeredness services to the community. Thus, the objective of this study is to explore and describe the factors influencing patient-centered care provision and nurses’ experience in Primary Health Care facilities. An exploratory qualitative approach with purposive sampling was used to gather data. Individual interviews with 35 nurses were conducted using a semi-structure interview guide question in the Primary Health Care settings in Nigeria. Each of the interviews with the nurses lasted for 25 minutes to one hour. All interviews were audio-taped, and transcribed verbatim using Microsoft Word. The transcripts were read and re-read, coded using NVivo version 12 software to organize the relevant information and categorized them into themes and sub-themes. Thematic analysis guided this study. The findings revealed three themes and sub-themes. The impact of environmental factors with two subthemes—suitable working environment and coordinated care;resources—shortage of staff and inadequate resources as sub-themes, and lastly, cultural sensitivity and religious influence—communication. Poor implementation of PCC strategies in most of the PHC facilities could lead to poor patient care and a lack of job satisfaction among nurses. This study identified that nurses have both negative and positive experience in providing patient-centered care health services. Providing patient-centered care in the Primary Health Care setting promotes the goal of achieving universal health coverage in Nigeria if the government would prioritize nurses’ pay, employ more staff, provide a conducive working environment, and opportunities for further training programs for nurses to enable and empower them with the necessary knowledge and skills. This, in turn, will translate into a range of outcomes that are socially valued, such as health responsiveness, health coverage and fairness.
文摘Globally, patient-centered care has become the focus of the healthcare system. It is imperative to note that during a global pandemic crisis, patient-centered care principles seek to empower partnering approaches in Primary Health Care (PHC), and have recently gained prominence in nursing practice and applied nursing research. However, nurses are faced with challenges in achieving the desired results in the PHC system. Thus, the study aimed to explore the factors that influence PCC utilization in the PHC facilities in Nigeria. A qualitative exploratory-descriptive design was used for this study. Data collection was conducted with the nurses from PHC facilities through individual interviews. Data saturation was achieved with 35 participants from 30 PHC facilities in Osun State, Nigeria, using a purposive sampling technique. All interviews were audio-recorded, later transcribed verbatim, and analyzed using the thematic analysis approach. NVivo 12 software was used for data management. The results from this study were categorized into two factors: Organizational factors and individual factors. Six themes that emerged from the study include inadequate management support, insufficient opportunities for further training, work overload and time constraints, health personnel readiness to use PCC, dearth enthusiasm for change, and poor nurses’ Accountability. The study shows that nurses encountered diverse challenges in providing patient-centered care. To improve the quality of healthcare delivery in the PHC facilities, there is a need to reinforce adequate management support, education, continued training, and the internal motivation of nurses to achieve transformative health outcomes in the community.
文摘Integration of Palliative Care into Primary Health Care will have a substantial amount of positive impact on Health Care in Nakuru County,Kenya.Consequently,all aspects of Palliative Care should be given to more than 2/3 population that suffer from cancers and chronic illnesses which sometimes overflow to some acute conditions.While Palliative Care focuses on Holistic Care encompassing physical,psychological,social,and spiritual aspects to adults and children,Primary Health Care operates on the principles of equity,solidarity,universal access to services,multisectoral action,social justice,centralization,and community participation.Thus,there are similarities in Palliative Care and Primary Health Care putting into consideration that the latter is based on practical,scientifically sound and socially accepted methods and technology.It is affordable,universally accessible to individuals and families in the community.Universal Health Coverage ensures that all people and communities have access to promotive,preventive,curative,rehabilitative,and palliative health services they need,of sufficient quality to be effective while also ensuring that the use of these services does not expose the users to financial hardships.The 60%of the Nakuru County population are in need of Palliative Care services,but only about 20%access these services.They suffer from cancers,non-communicable diseases,dementia,and frailty.Geographical challenges,staff shortages,and lack of Palliative Care knowledge are the main barriers to provision of care.
文摘This study aims to identify the actions performed by nurses of the Family Health Strategy with the pregnancy cycle of adolescents and analyze if the actions developed by these nurses are focused on risk prevention in pregnancy and childbirth. It is a qualitative and exploratory research in basic health units with 12 nurses. A semi-structured interview technique was applied, and the speeches were analyzed using content analysis. In the analysis of the results, it was identified two thematic categories in which it was noted that nurses during the prenatal make the reception of pregnant adolescents differently and conduct guidelines on examination, signs and symptoms of possible complications during the pregnancy and still emphasize the importance of educational activities as groups of pregnant women to be a chance of coexistence and exchange of experiences, doubts, and anxieties among themselves. It is concluded that the care provided by nurses is fundamental for the pregnant adolescents having prenatal with more quality.
文摘Objectives: The goal of this project was to evaluate the quality of the accessibility of the adult population to services in Primary Health Care, with a view to contribute to the development of measures that will propose improvement in the offered assistance. Methods: This is a quantitative and evaluative study made in the municipality of Santa Cruz, State of Rio Grande do Norte, Brazil, with a sample of 180 people. The study was approved by the Ethics and Research Committee of the Federal University of Rio Grande do Norte under Opinion number 152/2012. Results: It was found that the adult population classified the quality of care from regular to good, showing an association with the waiting time, time spent from the unit to one’s house and the reception. Conclusions: It could be concluded that this study contributes to the development of strategies able to provide a full and equitable care to the adult population in the primary health care network, since this is the gateway to other levels of care, because it aims to promote adult health and prevent diseases.
文摘Objective: To assess comprehensive care in the elderly population, as well as the quality of care in Primary Health Care. Methods: This is an exploratory descriptive study with a quantitative approach, conducted from July to December 2012, in the city of Santa Cruz, Rio Grande do Norte, Brazil. A sample of 130 subjects chosen by drawn was calculated, and data collection was performed at their homes. Results: There were interviewed 130 people, 92 (70.8%) women and 38 men (29.2%), with a minimum age of 60 and maximum of 96 years, with a mean of 72.8, median of 72.0 and a standard deviation of 8.3. Regarding the quality of care ratings of the PHC team, 48.5% (n = 63) of respondents stated this to be good, while 32.3% (n = 42) rated this as fair. Conclusions: In this perspective, one of the most appreciated meanings that were given to comprehensive care by health care professionals refers to holistic knowledge of each patient, resulting in the non-fragmentation of care. Thus, it is noticed that comprehensiveness has some weaknesses that need to be corrected, which shows the need for education and training of professionals assigned to primary health care services.
基金grants from the Medical Research Council of Southeast Sweden (FORSS) Futurum County Council of Jönköping Sweden
文摘Objective: To study changes in lifestyle and biological risk markers in a 24-year follow-up study, and occurrences of cardiovascular diseases (CVD), cancer and total mortality from official registers. Design: A 24-year follow-up survey and register study of a cohort of men 33 - 42 years old, examined with a health profile at baseline. With the health profile based on lifestyle, biological risk markers, self-rated mental stress and mental health, the men were separated in different risk groups. Setting: Primary health care center of Habo in Sweden. Subjects: All 757 men, 33 - 42 years old, and living in the community of Habo in Sweden in 1985. Main Outcome Measures: Lifestyle, biological risk markers, morbidity from CVD and cancer, and total mortality. Results: Smoking and physical activity decreased during follow-up time while alcohol consumption increased. Biological risk markers, except diastolic blood pressure, deteriorated significantly with age. Based on three- lifestyle groups, 16 % of the men had a more favorable lifestyle and 19% had a less favorable life-style at follow-up compared with baseline. The men, who had been classified as high-risk, based on the health profile at baseline, had a significantly higher incidence of CVD and cancer in the register study compared to men in a low-risk group. The baseline non-participant group had a significantly higher incidence of CVD and a higher mortality compared to the low-risk group. Conclusion: A health profile with a combination of lifestyle factors and biological risk markers can already at the age of 33 - 42 years predict incidence of CVD and cancer on group level among men after 24 years.
基金Source of the project:the Social Science Planning Fund Project of Liaoning Province(L19BG034)the Philosophy and Social Science Planning Key Project of Shenyang City(SZ202001L)the Key Project of Shenyang Social Science Funding(SYSK2020-04-01).
文摘Objective To explore the different modes and approaches of medical and preventive integration in current primary health care institutions in China.Methods Through literature analysis,field research,telephone interviews,and other methods the implementation status was evaluated to systematically study the main experience and effect of implementing medical and preventive integration services in pilot areas.Results and Conclusion At present,there are three implementation modes of medical-prevention integration,namely,vertical mode based on the medical community,internal mode with optimized service process,and internal mode with great service capabilities.The three medical-prevention integration modes have their respective focuses,but they need to be further improved in terms of policy support,technical staffing,information system construction,and drug use.
文摘Introduction: The involvement of undergraduate student at the beginning of their training in activities based on Primary Health Care (PHC), provides preventive and health promoting actions, and ensures the evaluation of the vulnerability of communities and people. Objectives: To analyze the opinion of students and teachers of two medicine higher education institutions on the relevance of Primary Health Care in this course. METHODS: Students and teachers should be effectively enrolled in order for the study to be conducted, being chosen in a random manner and without interferences on the part of the researchers so that the work was as reliable as possible. A cross-sectional study was conducted with interviews structured in questionnaires about what they thought about PHC. To some students and teachers of the medical course of Valen?a and Grande Rio University (UNIGRANRIO). Before receiving the questionnaire, all interviewed signed a Free and Informed Consent Term, which included the objectives and methodology of the work. Results: 310 students and 51 teachers participated in the study, where 91.43% of the students and 100% of the teachers affirmed that primary care plays a fundamental role in medical education. 94.86% of students and 97.91% of teachers, claimed that the discipline allows a greater contact between undergraduates and community. When questioned about the encouragement that teachers give to students to pursue a career in PHC, 57.87% of the students and 70.83% of the professors said they lacked in such a stimulus. Conclusion: PHC is still very neglected by governmental policies, educational institutions and by the own teachers, that often, turn they attention only to tertiary medicine and, as a consequence, a discouragement of this area occur. Therefore, a higher PHC value is necessary, allowing a more humane look at the patient, valuing their feelings, anguishes and their pathological framework.
基金This study was part of a doctoral study funded by the Indonesia Directorate General of Higher Education
文摘Purpose:The aim of this study was to examine the self-care practices and health-seeking behaviours of older adults in urban Indonesia.Methods:The cross-sectional study was performed from January to March 2014 in the Tammua sub-district of Indonesia.At the time of the study,273 older adults resided in Tammua,and half of them(51.2%)participated in this study.Data collection was carried out including self-care practices,health literacy,self-efficacy and basic conditioning factors.Results:It was found that most respondents(124;88.6%)always ate various protein sources daily.However,many participants never limited consumption of sugar(55;39.3%)or salt(40;28.6%),and more than half of respondents(96;68.6%)did not regularly visit MHCs.Health status(p<0.05),health maintenance(p<0.01)and salt limitation(p<0.05)were all significantly associated with salt limitation.It was found that respondents with higher selfefficacy,those who did not want to get information,and those of younger ages are less likely to visit MHCs regularly.Conclusion:An understanding of self-care practices and self-efficacy is needed to improve health care in developing countries.High self-efficacy should be promoted along with adequate health literacy.Older persons should learn the importance of regular health examinations to promote health,prevent diseases,and slow the progress of chronic diseases.The number of respondents who never limit their sugar and salt intake was especially surprising.An intervention program should be developed to limit salt and sugar intake of Indonesian elderly and to motivate older persons to use primary health services.
文摘Background Longevity,combined with a higher prevalence of obesity,particularly visceral obesity,has been associated with an increased risk of cardiovascular diseases.Insulin resistance(IR)is an important link between visceral obesity and cardiovascular diseases.An important association has been found between sagittal abdominal diameter,visceral obesity and IR.The objective of this study is to evaluate sagittal abdominal diameter as a marker of visceral obesity and correlate it with IR in older primary health care patients.Methods A cross-sectional study was performed with 389 patients over 60 years of age(70.6±6.9),of whom 74%were female.Their clinical,anthropometric and metabolic profiles were assessed and their fasting serum insulin level was used to calculate the homeostasis model assessment insulin resistance(HOMA-IR).Sagittal abdominal diameter was measured in the supine position at the midpoint between the iliac crest and the last rib with abdominal calipers.Results Sagittal abdominal diameter was significantly correlated with anthropometric measures of general and visceral obesity and with HOMA-IR in both genders.There was no change in the association between sagittal abdominal diameter and HOMA-IR after adjusting for age,sex,diabetes and hypertension.Conclusion It is feasible to use sagittal abdominal diameter in older primary care patients as a tool to evaluate visceral obesity,which is an indicator of cardiovascular risk.
文摘Background:Recruiting research participants from primary care in rural Appalachia is a major challenge and can be influenced by cultural characteristics,making it critically important to incorporate strategies of cultural competence in the overall design of clinical research.Objectives:The purpose of this paper is to describe culturally competent strategies used for recruitment and data collection with a sample of adults with type 2 diabetes from primary care settings in Appalachia.Design:The Purnell model of cultural competence and relevant literature served as a framework for study design.Four overarching approaches informed the organization of recruitment strategies and development of the data collection plan.Procedures:The approaches included selection of research sites,establishing collaborations,sustaining collaborative relationships,and enhancing understanding of benefits of participation.Four recruitment sites were selected based on potential to enhance diversification of participants;multiple steps were included in each of the three remaining approaches to build relationships and gain participation.A study log was maintained to provide evaluation data.Results:Recruitment took 14 months and a sample of 102 subjects provided consent with 101 participants providing complete data.Demographics were representative of the region except that African American participation was higher(6.9%)compared to current north central Appalachia(3%).Over 72%of participants indicated they would be interested in participating in future studies.Conclusions:These findings emphasize the importance of employing strategies for cultural competence in study design.Use of concepts from the Purnell model led to enhanced representativeness and potential for subsequent generalizability.
文摘The progressive aging of society has become a global concern, and is expected to lead to the development of effective, sustainable, person-centered, integrated community-based care systems. However, there is insufficient evidence regarding effective integrated community-based care. In particular, few studies have focused on social aspects of the community environment related to elderly health. This study aimed to consider social aspects as evaluation items, focusing particularly on social determinants from the perspective of community-dwelling people, to explore truly effective integrated community-based care to improve elderly health. The definition of social determinants means social cohesion in social and community contexts. A literature review of English articles published in peer-reviewed journals up to October 2019 was conducted using PubMed, MEDLINE, and CINAHL with the following search terms: “social cohesion,” “elderly health,” “mental health” and “community.” Identified articles were screened based on title and abstract, and selected articles were subjected to full-text assessment and critical review. All references cited in the selected articles were also reviewed. The following inclusion criteria were used: 1) studies targeting community-dwelling elderly people or community-dwelling people including elderly people as participants;2) studies with clear descriptions of social factors in the Methods section;and 3) studies with clear descriptions of health-related items in the Methods section. From the 21 articles analyzed, of which 9 articles defined social determinants as social cohesion in social and community context, 37 items were extracted as social aspects at the community level that reflect the perspective of residents. These items can be developed as evaluation items for community-based health care outcomes through consensus among community health care providers and further investigation.
文摘Objective: To evaluate the essential attribute of Primary Health Care, longitudinal care, care directed at children from birth to two years old. Methods: This is a descriptive and exploratory study of evaluative character and quantitative approach, conducted with parents/caregivers of 186 children, younger than two years old, patients of primary health care services in the city of Santa Cruz/RN, Brazil. For data collection, the instrument Primary Care Assessment Tools (PCA Tools) was used, and the results of the questions dealing with longitudinal attribute were evaluated. The data were stored and processed in Statistical Package for Social Sciences (SPSS). The study was approved by the Research Ethics Committee of the Health Sciences School of Trairí, under number 348896. Results: The mean age of children in months was 8.21;84.4% (n = 157) were assisted by the same doctor/nurse every time;in 81.7% (n = 152) of cases the doctor/nurse know the full medical history of the child;73.7% (n = 137) answered that the professional know their child more as a person than just as someone with a health problem;48.9% (n = 91) stated that the doctor/nurse do not know their family very well;86.6% (n = 161) reported finding the doctor/nurse understands what is saying or questioning;96.2 (n = 179) of respondents said the doctor/nurse answers the questions so that they understand;96.2% (n = 179) of the interviewed said they feel comfortable telling the concerns or problems of their child to the doctor/nurse;66.7% (n = 124) claimed that they would not change the service/doctor/nurse to another health service. Conclusion: It is concluded that the attribute was well rated by the mothers of children seen in primary health care services and that they can establish good communication and relationship with the health professionals who treat their children.
文摘Objective To explore the current situation and problems of the pharmacy organization and pharmaceutical services in primary medical and health institutions so as to provide a reference for improving relevant policies.Methods Multi-stage stratified random sampling was used to collect questionnaires from primary medical and health institutions in 5 provinces,and 102 questionnaires were distributed.Then Excel 2016 and IBM SPSS 21.0 software were applied for descriptive statistical analysis,chi-square test and multiple response analysis.Results and Conclusion A total of 92 primary medical and health institutions participated in the survey,and 92 valid questionnaires were recovered.The survey shows that 54.1%of the institutions have established more than 8 pharmaceutical administration regulations.63.5%and 31.8%of the institutions have formulated pharmaceutical administration and pharmacotherapy team charters(or management systems).29.7%of institutions have pharmacy personnel in accordance with relevant regulations.The higher proportion of pharmacy services are prescription review and adjustment,medication guidance,collecting and reporting adverse reactions,medication errors and medication hazard information.Primary medical and health institutions still need to further improve their pharmaceutical administration system,organizational structure,pharmacy professional training and clinical pharmacy service.