Primary Health Care (primary + health_care)

Distribution by Scientific Domains
Distribution within Medical Sciences

Terms modified by Primary Health Care

  • primary health care centre
  • primary health care provider
  • primary health care services
  • primary health care team

  • Selected Abstracts


    When Popular Participation Won't Improve Service Provision: Primary Health Care in Uganda

    DEVELOPMENT POLICY REVIEW, Issue 2 2005
    Frederick Golooba-Mutebi
    Advocates of participatory approaches to service delivery see devolution as key to empowering people to take charge of their own affairs. Participation is portrayed as guaranteeing the delivery of services that are in line with user preferences. It is assumed that people are keen to participate in public affairs, that they possess the capacity to do so, and that all they need is opportunities. Using evidence from ethnographic research in Uganda, this article questions these views. It shows that, to succeed in the long term, devolution and participation must take place in the context of a strong state, able to ensure consistent regulation, and a well-informed public backed up by a participatory political culture. [source]


    Qualitative research to make practical sense of sustainability in primary health care projects implemented by non-governmental organizations

    INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 1 2004
    Eric G. Sarriot
    Abstract Sustainability continues to be a serious concern for Primary Health Care (PHC) interventions targeting the death of millions of children in developing countries each year. Our work with over 30 Non-Governmental Organizations (NGOs) implementing USAID's Child Survival and Health Grants Program (CSHGP)-funded projects revealed the need for a study to develop a framework for sustainability assessment in these projects. We surveyed NGO informants and project managers through semi-structured interviews and questionnaires. This paper summarizes our study findings. The NGOs share key values about sustainability, but are skeptical about approaches perceived as disconnected from field reality. In their experience, sustainable achievements occur through the interaction of capable local stakeholders and communities. This depends strongly on enabling conditions, which NGO projects should advance. Sustainability assessment is multidimensional, value-based and embeds health within a larger sustainable development perspective. It reduces, but does not eliminate, the unpredictability of long-term outcomes. It should start with the consideration of the ,local systems' which need to develop a common purpose. Our ability to address the complexity inherent to sustainability thinking rests with the validity of the models used to design interventions. A participant, qualitative research approach helped us make sense of sustainability in NGO field practice. Copyright © 2004 John Wiley & Sons, Ltd. [source]


    Epidemiology of low back pain in the United Arab Emirates

    INTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 3 2004
    Abdulbari BENER
    Abstract Aims:, Low back pain (LBP), a common presenting problem in general practice in the United Arab Emirates (UAE), has received increasing attention in recent decades. We seek to investigate the prevalence of LBP and associated risk factors among people living in the typically hot, humid desert environment of the UAE. Methods:, A cross-sectional questionnaire survey was conducted. The setting was the Primary Health Care (PHC) Clinics in Al-Ain, UAE. The subjects were a multistage stratified sample of 1304 UAE nationals, 15,70 years of age, who attended PHC clinics for any reason. All subjects were invited to participate. The questionnaire used in the survey is a modified version of the Roland-Morris scale for evaluating low back pain. The questionnaires were administered during face-to-face interviews conducted in Arabic by qualified nurses. Results:, Of the total 1304 subject, 1103 (84.5%) living in both urban and rural areas agreed to participate and responded to the study; 586 (53.1%) were men and 517 (46.9%) women. The mean ages and SD of the subjects were 34.9 ± 13.4 years for the men and 33.5 ± 11.8 years for the women. The prevalence of LBP in the present study was 64.6% (95% CI = 60.7,68.5). The results revealed that there were statistically significant differences between men and women with respect to LBP and body mass index (BMI) (P < 0.001), marital status (P < 0.001), occupational status (P < 0.001), housing condition (P < 0.001), and smoking habits (P < 0.001). Back pain had a greater influence on the lifestyle habits of the women than men. Stepwise multiple regression analysis showed that only BMI (OR = 2.54, 95% CI = 2.30,281; P < 0.001), prolonged standing (OR = 6.22, 95% CI = 4.01,9.67; P < 0.0001), weakness in leg (OR = 2.11, 95% CI = 1.16,3.85; P = 0.0142), lifting heavy weights (OR = 6.34, 95% CI = 4.09,9.84; P = 0.019) regular exercise (OR = 12.47, 95% CI = 7.50,20.71; P < 0.001) and smoking habits (OR = 1.61, 95% CI = 1.08,2.38; P < 0.05) had a significant effect on the presence of LBP in these patients. Conclusions:, The study showed that the prevalence of back-related disability was higher among women than men in the UAE. Also, low socio-economic status and adverse lifestyle habits may constitute risk factors and predictors of LBP. [source]


    Spanish primary health care nurses who are smokers: this influence on the therapeutic relationship

    INTERNATIONAL NURSING REVIEW, Issue 3 2009
    S. González rn
    Aim:, To identify the perception of Primary Health Care (PHC) female nurses in the Balearic Islands in Spain who are smokers, regarding the suitability of their anti-smoking therapeutic relationships with their clients. Also, to identify what factors they consider may determine why nurses smoke less in PHC than in specialized care (SC). Background:, Backed by the signing of the WHO Framework Convention on Tobacco Control (WHO FCTC), a new Anti-Smoking law has been in force in Spain since 2006. This legislation limits the places where tobacco may be consumed. PHC nurses, because of their professional abilities, their number and their direct contact with society on all accounts , both health- and illness-wise , and also because of the proven efficacy of their interventions in the fight against the smoking habit, are called upon to play an important role against the smoking habit in the 21st century. Method:, A qualitative study using a semi-structured interview with 15 PHC female nurses who are smokers. Findings:, Regarding the therapeutic relationship, basically two attitudes are adopted: first, blaming themselves and feeling uncomfortable and inadequate to be able to help someone to give up smoking or, second, considering themselves to be in an optimum situation in which to be able to help by sharing their addiction and thereby understanding and empathizing much more with clients. PHC nurses believe they smoke less than SC nurses as a result of a greater degree of awareness. Conclusion:, We would suggest that SC nurses should acquire a more relevant role in the fight against the smoking habit. In light of their capacity, commitment and efficacy, we believe there is a case for total autonomy as far as their role as therapists in breaking smoking habits is concerned. [source]


    Primary Health Care and its impact on nursing regulation

    INTERNATIONAL NURSING REVIEW, Issue 1 2009
    Anne Morrison RN, BEdSt, MAICD, MRCNA
    No abstract is available for this article. [source]


    Building healthier nations through Primary Health Care

    INTERNATIONAL NURSING REVIEW, Issue 1 2009
    Editor, Jane J. A. Robinson FRCN
    No abstract is available for this article. [source]


    Peer observation of teaching in the online environment: an action research approach

    JOURNAL OF COMPUTER ASSISTED LEARNING, Issue 5 2008
    D. Swinglehurst
    Abstract This paper describes a collaborative action research approach used to explore peer observation of teaching (POT) within the online environment. Although POT has become familiar in face-to-face teaching contexts, little is understood of its potential role in online settings. We conducted ,virtual' focus groups to explore the experience and views of 28 teachers and subjected our data to a thematic analysis. This informed the implementation of an innovative programme of POT, ,Peer-to-peer Reflection on Pedagogical Practice' (PROPP) among tutors of a Web-based MSc in International Primary Health Care at University College London. Modeled on an action learning set, the programme encourages collaborative reflection on teaching practices, based on participants' specific examples of online teaching. The PROPP model is consistent with Quality Enhancement, which we distinguish from Quality Assurance. Here, we describe the implementation of the PROPP programme within an action research framework and identify the factors that we consider critical to the success of peer observation within online courses. We highlight examples of aspects of teaching that have been discussed within the PROPP programme and offer suggestions of the kinds of evidence that could be incorporated into a portfolio to demonstrate the effectiveness of such an initiative. [source]


    Gendering Local Knowledge: Medicinal Plant Use and Primary Health Care in the Amazon

    MEDICAL ANTHROPOLOGY QUARTERLY, Issue 2 2001
    Coral Wayland
    First page of article [source]


    Under-report and underdiagnosis of chronic respiratory diseases in an African country

    ALLERGY, Issue 7 2009
    P. Martins
    Background:, Chronic respiratory diseases (CRD) are greatly underestimated. The aim of this study was to assess the burden associated with reported CRD and chronic obstructive pulmonary disease, as defined on the basis of various standardized criteria, by estimating their point prevalence in a sample of individuals attending the Primary Health Care (PHC) level and Emergency Room (ER) Departments in Cape Verde (CV) archipelago. The second aim of the study was to identify factors related to airways obstruction and reported CRD in this population. Methods:, A cross-sectional study was carried out in CV during 2 weeks. Outpatients aged more than 20 years seeking care at PHC level and ER answered a standardized questionnaire and were subjected to spirometry, independently of their complaint. Two criteria for airways obstruction were taken into account: forced expiratory volume (FEV1) <80% of the predicted value and FEV1/forced vital capacity (FVC) ratio <0.70. Results:, A total of 274 individuals with a satisfactory spirometry were included. 22% of the individuals had a FEV1 < 80%. Individuals older than 46 years had a higher risk of having airways obstruction. Asthma diagnosis (11%) had a clear association with airways obstruction. Smoking was a risk factor for a lower FEV1. Working in a dust place and cooking using an open fire were both related to chronic bronchitis and asthma diagnosis. Conclusion:, Under-report and underdiagnosis of chronic respiratory conditions seem to be a reality in CV just as in other parts of the world. To improve diagnosis, our results reinforce the need of performing a spirometry. [source]


    Harm reduction programmes in the Asia,Pacific Region

    DRUG AND ALCOHOL REVIEW, Issue 1 2008
    GARY REID MPH
    Abstract Introduction and Aims. This paper reports on the public health intervention of harm reduction to address drug use issues in the Asia , Pacific region. Design and Methods. It is based on the report ,Situational analysis of illicit drug issues and responses in Asia and the Pacific', commissioned by the Australian National Council on Drugs Asia Pacific Drug Issues Committee. A comprehensive desk-based review based on published and unpublished literature and key informant data. Results. Drug use in the Asia , Pacific region is widespread, resulting in serious adverse health consequences. Needle and syringe programmes are found in some parts of Asia, but not in the six Pacific Island countries reviewed. Outreach and peer education programmes are implemented, but overall appear minor in size and scope. Substitution therapy programmes appear to be entering a new era of acceptance in some parts of Asia. Primary health care specifically for drug users overall is limited. Discussion and Conclusions. Harm reduction programmes in the Asia , Pacific region are either small in scale or do not exist. Most programmes lack the technical capacity, human resources and a limited scope of operations to respond effectively to the needs of drug users. Governments in this region should be encouraged to endorse evidence-based harm reduction programmes. [source]


    Determinants of health status and the influence of primary health care services in Latin America, 1990,98

    INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 4 2003
    David Moore
    Abstract Primary health care (PHC) services have been advocated as a means by which less developed countries may improve the health of their populations even in the face of poverty, low levels of literacy, poor nutrition and other factors that negatively influence health status. Using aggregated data from the World Bank and UNICEF this study examined which factors, both within the health care system and outside of it, are associated with under-5 mortality rates in 22 countries of Latin America and the Caribbean during the 1990s. In a multivariate analysis using generalized estimating equations for repeated measures, five factors were found to be independent predictors of lower under-5 mortality rates (U5MRs). These were vaccination levels, female literacy, the use of oral rehydration therapy, access to safe water and GNP per capita. When the magnitude of these associations were assessed, higher levels of GNP per capita was found to be very weakly associated with lower U5MRs, compared with female literacy and vaccination rates. These findings suggest that government policies which focus only on promoting economic growth, while not making important investments in PHC services, female education and access to safe water are unlikely to see large improvements in health status. Copyright © 2003 John Wiley & Sons, Ltd. [source]


    District health systems in a neoliberal world: a review of five key policy areas,

    INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue S1 2003
    Malcolm Segall
    Abstract District health systems, comprising primary health care and first referral hospitals, are key to the delivery of basic health services in developing countries. They should be prioritized in resource allocation and in the building of management and service capacity. The relegation in the World Health Report 2000 of primary health care to a ,second generation' reform,to be superseded by third generation reforms with a market orientation,flows from an analysis that is historically flawed and ideologically biased. Primary health care has struggled against economic crisis and adjustment and a neoliberal ideology often averse to its principles. To ascribe failures of primary health care to a weakness in policy design, when the political economy has starved it of resources, is to blame the victim. Improvement in the working and living conditions of health workers is a precondition for the effective delivery of public health services. A multidimensional programme of health worker rehabilitation should be developed as the foundation for health service recovery. District health systems can and should be financed (at least mainly) from public funds. Although in certain situations user fees have improved the quality and increased the utilization of primary care services, direct charges deter health care use by the poor and can result in further impoverishment. Direct user fees should be replaced progressively by increased public finance and, where possible, by prepayment schemes based on principles of social health insurance with public subsidization. Priority setting should be driven mainly by the objective to achieve equity in health and wellbeing outcomes. Cost effectiveness should enter into the selection of treatments for people (productive efficiency), but not into the selection of people for treatment (allocative efficiency). Decentralization is likely to be advantageous in most health systems, although the exact form(s) should be selected with care and implementation should be phased in after adequate preparation. The public health service should usually play the lead provider role in district health systems, but non-government providers can be contracted if needed. There is little or no evidence to support proactive privatization, marketization or provider competition. Democratization of political and popular involvement in health enhances the benefits of decentralization and community participation. Integrated district health systems are the means by which specific health programmes can best be delivered in the context of overall health care needs. International assistance should address communicable disease control priorities in ways that strengthen local health systems and do not undermine them. The Global Fund to Fight AIDS, Tuberculosis and Malaria should not repeat the mistakes of the mass compaigns of past decades. In particular, it should not set programme targets that are driven by an international agenda and which are achievable only at the cost of an adverse impact on sustainable health systems. Above all the targets must not retard the development of the district health systems so badly needed by the rural poor. Copyright © 2003 John Wiley & Sons, Ltd. [source]


    Effective interprofessional teams: "Contact is not enough" to build a team

    THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2008
    Joan Sargeant PhD
    Abstract Introduction: Teamwork and interprofessional practice and learning are becoming integral to health care. It is anticipated that these approaches can maximize professional resources and optimize patient care. Current research, however, suggests that primary health care teams may lack the capacity to function at a level that enhances the individual contributions of their members and team effectiveness. This study explores perceptions of effective primary health care teams to determine the related learning needs of primary health care professionals. Methods: Primary health care team members with a particular interest in teamwork shared perspectives of effective teamwork and educational needs in interprofessional focus groups. Transcripts from nine focus groups with a total of 61 participants were analyzed using content analysis and grounded hermeneutic approaches to identify themes. Results: Five themes of primary care team effectiveness emerged: (1) understanding and respecting team members' roles, (2) recognizing that teams require work, (3) understanding primary health care, (4) working together: practical "know-how" for sharing patient care, and (5) communication. Communication was identified as the essential factor in effective primary health care teams. Discussion: Several characteristics of effective primary health care teams and the related knowledge and skills that professionals require as effective team members are identified. Effective teamwork requires specific cognitive, technical, and affective competence. [source]


    Aboriginal Health Workers , Primary health care at the margins

    AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2007
    Article first published online: 7 JUN 200
    No abstract is available for this article. [source]


    Primary health care personnel faced with cadaveric organ donation: a multicenter study in south-eastern Spain

    CLINICAL TRANSPLANTATION, Issue 5 2008
    A. Ríos
    Abstract:, Introduction:, Primary health care (PHC) is the first point of contact between the public and the health system and it is an important channel for the communication and promotion of organ donation and transplantation. The objective of this study was to analyze the attitude of PHC personnel toward donation and to determine the psychosocial variables affecting this attitude. Materials and methods:, A random sample was stratified by job category and geographical location among PHC personnel (n = 482) from 32 health centers. Attitude was evaluated using a questionnaire validated in our local area. (It was completed anonymously and was self-administered.) Results:, The questionnaire completion rate was 86% (n = 414): 78% (n = 325) are in favor and the remaining 22% (n = 89) are either against or are not sure. The reason given for a negative attitude is fear of apparent death (16%; n = 14). There are many independent factors that affect attitude: (i) job category (OR = 2.4); (ii) knowledge of the concept of brain death (OR = 2.2); (iii) a preference for alternatives to burial (OR = 2.99); (iv) being in favor of cremation (OR = 01.87) and (v) knowledge of the attitude of one's partner toward organ donation (OR = 0.312). Conclusion:, PHC personnel have a favorable attitude toward donation, especially physicians, although it would be useful to provide more information to PHC personnel. Physicians could be a key element in the direct and indirect promotion of donation and transplantation. [source]


    Screening for depression and anxiety disorders in primary care patients

    DEPRESSION AND ANXIETY, Issue 7 2007
    Adomas Bunevicius B.S.
    Abstract Mood and anxiety disorders are highly prevalent in primary health care. In this study we assessed performance of the Hospital Anxiety and Depression Scale (HADS) for screening of depression and anxiety disorders in a population of primary care patients. A total of 503 primary care patients consecutively admitted to the primary care medical center in Kaunas, Lithuania, completed the study. We found that the HADS subscale of depression (HADS-D) at a cutoff score of 6 or more showed the best performance screening for a major depressive episode diagnosed by means of the Mini International Neuropsychiatric Interview (MINI), with a sensitivity of 80%, specificity of 69%, positive predictive value of 80%, negative predictive value of 92%, and area under the receiver operating characteristic (ROC) curve of 0.75. Performance of the HADS-D against MINI diagnosis of dysthymia was weak. The HADS subscale of anxiety (HADS-A) at a cutoff score of 9 or more showed the best performance screening for MINI diagnosis of overall anxiety disorders, with a sensitivity of 77%, specificity of 75%, positive predictive value of 53%, negative predictive value of 90%, and area under the ROC curve of 0.76. These results suggest that in primary care patients HADS is an adequate screening instrument for the MINI diagnoses of major depressive episode, but not for dysthymia at a cutoff score of 6, and for anxiety disorders at a cutoff score of 9. Depression and Anxiety 24:455,460, 2007. © 2006 Wiley-Liss, Inc. [source]


    ETHICS BEYOND BORDERS: HOW HEALTH PROFESSIONALS EXPERIENCE ETHICS IN HUMANITARIAN ASSISTANCE AND DEVELOPMENT WORK

    DEVELOPING WORLD BIOETHICS, Issue 2 2008
    MATTHEW R. HUNT
    ABSTRACT Health professionals are involved in humanitarian assistance and development work in many regions of the world. They participate in primary health care, immunization campaigns, clinic- and hospital-based care, rehabilitation and feeding programs. In the course of this work, clinicians are frequently exposed to complex ethical issues. This paper examines how health workers experience ethics in the course of humanitarian assistance and development work. A qualitative study was conducted to consider this question. Five core themes emerged from the data, including: tension between respecting local customs and imposing values; obstacles to providing adequate care; differing understandings of health and illness; questions of identity for health workers; and issues of trust and distrust. Recommendations are made for organizational strategies that could help aid agencies support and equip their staff as they respond to ethical issues. [source]


    Implementation of brief alcohol intervention in primary health care: do nurses' and general practitioners' attitudes, skills and knowledge change?

    DRUG AND ALCOHOL REVIEW, Issue 6 2005
    MAURI AALTO
    Abstract Brief alcohol intervention reduces heavy drinking, but its implementation has been challenging. The purpose was to evaluate self-reported changes in attitudes, skills and knowledge regarding brief intervention among nurses and general practitioners (GPs) during an implementation project. A questionnaire survey was used before and after the implementation to all nurses and GPs working at the time in the seven primary health-care centres of the city of Tampere, Finland. Several positive changes indicate an increased amount of knowledge regarding brief intervention among the professionals during the implementation. This was found especially among the nurses. The success in increasing the knowledge can also be seen in a decrease of training needs. Instead, attitudes and skills among the professionals did not seem to develop positively. Increasing motivational skills especially seems to be the future challenge. [source]


    Validation of the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): report of results from the Australian site

    DRUG AND ALCOHOL REVIEW, Issue 3 2005
    DAVID A. L. NEWCOMBE
    Abstract The concurrent, construct, discriminative and predictive validity of the World Health Organization's Alcohol Substance Involvement Screening Test (ASSIST) were examined in an Australian sample. One hundred and fifty participants, recruited from drug treatment (n = 50) and primary health care (PHC) settings (n = 100), were administered a battery of instruments at baseline and a modified battery at 3 months. Measures included the ASSIST; the Addiction Severity Index-Lite (ASI-Lite); the Severity of Dependence Scale (SDS); the MINI International Neuropsychiatric Interview (MINI-Plus); the Rating of Injection Site Condition (RISC); the Drug Abuse Screening Test (DAST); the Alcohol Use Disorders Identification Test (AUDIT); the Revised Fagerstrom Tolerance Questionnaire (RTQ); and the Maudsely Addiction Profile (MAP). Concurrent validity was demonstrated by significant correlations between ASSIST scores and scores from the ASI-lite, SDS, AUDIT and DAST; and significantly greater ASSIST scores for those with diagnoses of abuse or dependence. Construct validity was established by significant correlations between ASSIST scores and measures of risk factors for the development of drug and alcohol problems. Participants diagnosed with attention deficit/hyperactivity disorder or antisocial personality disorder had significantly higher ASSIST scores than those not diagnosed as such. Discriminative validity was established by the capacity of the ASSIST to discriminate between substance use, abuse and dependence. ROC analysis was able to establish cut-off scores for an Australian sample, with suitable specificities and sensitivities for most substances. Predictive validity was demonstrated by similarity in ASSIST scores obtained at baseline and at follow-up. The findings demonstrated that the ASSIST is a valid screening test for psychoactive substance use in individuals who use a number of substances and have varying degrees of substance use. [source]


    Validation of the alcohol, smoking and substance involvement screening test (ASSIST)

    ADDICTION, Issue 6 2008
    Rachel Humeniuk
    ABSTRACT Aim The concurrent, construct and discriminative validity of the World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were examined in a multi-site international study. Participants One thousand and 47 participants, recruited from drug treatment (n = 350) and primary health care (PHC) settings (n = 697), were administered a battery of instruments. Measurements Measures included the ASSIST; the Addiction Severity Index-Lite (ASI-Lite); the Severity of Dependence Scale (SDS); the MINI International Neuropsychiatric Interview (MINI-Plus); the Rating of Injection Site Condition (RISC); the Drug Abuse Screening Test (DAST); the Alcohol Use Disorders Identification Test (AUDIT); the Revised Fagerstrom Tolerance Questionnaire (RTQ); and the Maudsley Addiction Profile (MAP). Findings Concurrent validity was demonstrated by significant correlations between ASSIST scores and scores from the ASI-Lite (r = 0.76,0.88), SDS (r = 0.59), AUDIT (r = 0.82) and RTQ (r = 0.78); and significantly greater ASSIST scores for those with MINI-Plus diagnoses of abuse or dependence (P < 0.001). Construct validity was established by significant correlations between ASSIST scores and measures of risk factors for the development of drug and alcohol problems (r = 0.48,0.76). Discriminative validity was established by the capacity of the ASSIST to discriminate between substance use, abuse and dependence. Receiver operating characteristic (ROC) analysis was used to establish cut-off scores with suitable specificities (50,96%) and sensitivities (54,97%) for most substances. Conclusions The findings demonstrated that the ASSIST is a valid screening test for identifying psychoactive substance use in individuals who use a number of substances and have varying degrees of substance use. [source]


    A long-standing World Health Organization collaborative project on early identification and brief alcohol intervention in primary health care comes to an end

    ADDICTION, Issue 5 2007
    NICK HEATHER
    No abstract is available for this article. [source]


    How can we increase the involvement of primary health care in the treatment of tobacco dependence?

    ADDICTION, Issue 3 2004
    A meta-analysis
    ABSTRACT Aims A systematic review of studies testing the effectiveness of educational and practice base strategies to increase the involvement of primary health-care practitioners in the treatment of tobacco dependence. Data sources MEDLINE, EMBASE, CINAHL and the Cochrane Library (1966,2001). Selection criteria included studies that used randomized or controlled clinical designs, controlled before and after trials and interrupted time-series designs and that presented objective and interpretable measures of practitioners' behaviour and biochemically verified patient quit rates. Review methods A meta-analysis, using a random effects model, of 24 programmes identified in 19 trials. Effect sizes were adjusted by inverse variance weights to control for studies' sample sizes. Findings Analyses to explain the heterogeneity of effect sizes found that interventions were equally effective in changing practitioners' screening and advice-giving rates and their patients' quit rates. Absolute increases for the intervention above the comparison groups were 15% (95% CI = 7,22) for screening rates, 13% (95% CI = 9,18) for advice-giving rates and 4.7% (95% CI = 2.5,6.9) for biochemically verified patient quit rates. Practitioners in training programmes were effective in changing their patients' quit rates but not their own screening rates; educational interventions were more effective than practice-based interventions. For established practitioners, programmes were effective in changing their screening and advice-giving rates, but not their patients' quit rates; a combination of practice-based and educational interventions were more effective. Conclusions Primary health-care practitioners can be engaged in the treatment of tobacco dependence to increase equally their screening and advice-giving rates and their patients' quit rates with outcomes of considerable public health and clinical significance. The provision of educational interventions for practitioners in training in combination with systematic outreach practice-based support for established practitioners is likely to be an effective strategy to increase smoking quit rates throughout primary health care. [source]


    Educational needs, metabolic control and self-reported quality of life

    EUROPEAN DIABETES NURSING, Issue 1 2005
    A study among people with type 2 diabetes treated in primary health care
    Abstract The prevalence of type 2 diabetes is increasing. In order to reduce long-term complications and to promote a better life for these patients, health care professionals are important advocates in education and counselling. More knowledge is therefore needed to explore the association between educational needs and quality of life. In total, 211 people with type 2 diabetes (response rate 48%) were recruited from general practices in a geographically well-defined district in Bergen, Norway. All participants completed a questionnaire measuring demographical and clinical variables, quality of life (WHOQOL-Bref), satisfaction with education and counselling, and symptoms related to the disease. A blood sample was taken from each patient for determination of HbA1c. The participants reported receiving most information on diet, physical activity and treatment and less information on foot care and long-term complications. Satisfaction with education was significantly positively correlated with self-reported overall quality of life, and quality of life within domains for psychological health, social relationships and environment. More intensive treatment was significantly associated with lower quality of life within the physical health and social relationships domains. For 32% of the participants, HbA1c values did not satisfy the Norwegian guidelines (adjusted for age). The results from the present study emphasise a need for health education in diabetes primary health care especially in relation to foot care and long-term complications. The association between satisfaction with education and quality of life makes it important to develop educational and counselling methods for nurses in primary health care. Copyright © 2005 FEND. [source]


    ,Taking off the suit': engaging the community in primary health care decision-making

    HEALTH EXPECTATIONS, Issue 1 2006
    Elizabeth Anderson MSc RGN
    Abstract Objective, To explore the process of public involvement in planning primary health care. Background, Recent policy in the UK promotes public involvement in planning health but there have been difficulties in engaging communities in the process. Surveys of health service organizations have found that there has been a failure to adapt to new approaches. It has become important to understand why this has occurred if policy initiatives to encourage involvement are to succeed. Design, Qualitative study. Data collected through individual interviews and focus groups. Setting, Two new primary healthcare developments in deprived areas in Bristol and Weston-Super-Mare. Participants, Thirty-six professionals and 23 local residents in Bristol; six professionals and three local residents in Weston-Super-Mare. Results, Three themes were identified: process, partnership and power. The main findings were that exceptional people with a shared commitment to public involvement were necessary to motivate others and develop partnerships. Local people were drawn into the process and with increased confidence became powerful advocates for their community. Creative and varied methods to involve the public were important in achieving balance between professionals and lay people. However, conflicts over practical decisions arose from a lack of clarity over who had power to influence decisions. Conclusion, Most of the participants were enthusiastic about their experience of public involvement in planning primary health care. Features crucial to sustainable involvement included a commitment from leaders within statutory agencies, support over a long period to build the confidence of local people, willingness to use informal approaches that are in tune with local culture, and a recognition of the concerns of both service users and providers. [source]


    Patient characteristics as predictors of primary health care preferences: a systematic literature analysis

    HEALTH EXPECTATIONS, Issue 2 2003
    Hans Peter Jung MD PhD GP
    Abstract Objective To identify associations between various cultural and demographic factors and patients' primary health care preferences. Search strategy Searches were performed in MEDLINE (1966,December 2000), PsycINFO (1977,May 2001) and Sociological Abstracts (1963,December 2000). Identified papers were checked for more papers. Inclusion criteria Studies with a focus on primary health care or health care in general, asking patients about preferences with regard to health care, reporting quantitative results and examining the relations between specific patient characteristics and patient preferences. Data extraction and synthesis Data were extracted from studies using a scoring form to register what methods were used, which patient characteristics were analysed and which patient characteristics significantly influenced patients' preferences with regard to different aspects of health care (P < 0.05). Main results A total of 145 studies were included with 2276 comparisons between subgroups of patients. Of all the comparisons, 607 (27%) showed a significant association between patient characteristics and preferences with regard to primary health care. Age and economic status significantly related to patient preferences in 38 and 33% of the comparisons, respectively. Education, health status, family situation, sex, and utilization of health care related significantly to patient preferences in less than 25% of the comparisons. Conclusions This review of the literature showed patient characteristics to be an important determinant of preferences regarding many aspects of primary health care defined as general practice care or health care, in general. All of the patient characteristics examined here showed at least some significant associations with preferences for primary health care. [source]


    District health systems in a neoliberal world: a review of five key policy areas,

    INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue S1 2003
    Malcolm Segall
    Abstract District health systems, comprising primary health care and first referral hospitals, are key to the delivery of basic health services in developing countries. They should be prioritized in resource allocation and in the building of management and service capacity. The relegation in the World Health Report 2000 of primary health care to a ,second generation' reform,to be superseded by third generation reforms with a market orientation,flows from an analysis that is historically flawed and ideologically biased. Primary health care has struggled against economic crisis and adjustment and a neoliberal ideology often averse to its principles. To ascribe failures of primary health care to a weakness in policy design, when the political economy has starved it of resources, is to blame the victim. Improvement in the working and living conditions of health workers is a precondition for the effective delivery of public health services. A multidimensional programme of health worker rehabilitation should be developed as the foundation for health service recovery. District health systems can and should be financed (at least mainly) from public funds. Although in certain situations user fees have improved the quality and increased the utilization of primary care services, direct charges deter health care use by the poor and can result in further impoverishment. Direct user fees should be replaced progressively by increased public finance and, where possible, by prepayment schemes based on principles of social health insurance with public subsidization. Priority setting should be driven mainly by the objective to achieve equity in health and wellbeing outcomes. Cost effectiveness should enter into the selection of treatments for people (productive efficiency), but not into the selection of people for treatment (allocative efficiency). Decentralization is likely to be advantageous in most health systems, although the exact form(s) should be selected with care and implementation should be phased in after adequate preparation. The public health service should usually play the lead provider role in district health systems, but non-government providers can be contracted if needed. There is little or no evidence to support proactive privatization, marketization or provider competition. Democratization of political and popular involvement in health enhances the benefits of decentralization and community participation. Integrated district health systems are the means by which specific health programmes can best be delivered in the context of overall health care needs. International assistance should address communicable disease control priorities in ways that strengthen local health systems and do not undermine them. The Global Fund to Fight AIDS, Tuberculosis and Malaria should not repeat the mistakes of the mass compaigns of past decades. In particular, it should not set programme targets that are driven by an international agenda and which are achievable only at the cost of an adverse impact on sustainable health systems. Above all the targets must not retard the development of the district health systems so badly needed by the rural poor. Copyright © 2003 John Wiley & Sons, Ltd. [source]


    Factors associated with quality of life of Brazilian older adults

    INTERNATIONAL NURSING REVIEW, Issue 1 2009
    L. Paskulin rn
    Objective:, The objective of the study was to explore factors associated with quality of life (QoL) of Brazilian community-dwelling older adults. Methods:, This was a descriptive exploratory cross-sectional study. Data were collected through a household survey. A random sample of 288 older adults from Porto Alegre, Brazil participated in the study. A demographic and health data sheet, the OARS activities of daily living (ADL) scale and the WHOQOL-BREF were administered. Results and Discussion:, The mean age of participants was 71.2 years (SD = 7.5) and 67.4% were female. Using multiple linear regression analysis, with overall QoL as the dependent variable, perceived health status, education level, engagement in physical activity, medical conditions, age group and use of primary health care were significant associated factors. With physical QoL as the dependent variable, significant factors included: perceived health status, medical conditions, education, physical activities and dependence in ADL; with social QoL as the dependent variable, only age group and paid work were significant. In relation to environmental QoL, education and perceived health were significant factors. Conclusions:, The results illustrate the complexity of factors influencing QoL. With a better understanding of these factors, it is possible to plan appropriate health interventions. [source]


    Primary health care nursing staff in Crete: an emerging profile

    INTERNATIONAL NURSING REVIEW, Issue 1 2006
    A. Markaki rn
    Background:, In 2001, the newly established Regional Health and Welfare System of Crete commissioned the first needs' assessment study of nursing personnel employed in the public sector of primary health care (PHC). Aim:, To capture the profile and professional needs of nursing staff working in Health Centers throughout the island of Crete and explore variations in nursing practice by educational preparation. Methods:, A newly developed, psychometrically tested questionnaire, was administered to all nursing staff in 14 rural Health Centers. Findings:, Vacancy rates are high, indicating a serious staffing deficit. The type of degree earned (2-year vs. 3 or 4-year program) does not differentiate nursing practice, with only two exceptions (obtaining a patient's history and counselling patients). The majority of respondents assess their existing knowledge and skills as ,adequate' while indicating a strong desire for continuing education. Job satisfaction is high in terms of interactions with clients and community recognition, while it is rated ,low' in terms of daily interactions with colleagues and support from work environment. Conclusion:, Cretan nursing staff in PHC operate within a restricted and task-orientated framework. Their educational preparation has little effect in practice role variations and professional needs. The Regional Health and Welfare System of Crete should address daily supervision and support issues, on-the-job training, continuing education needs, while taking immediate action to avoid potential turnover of existing staff and to aggressively recruit young, qualified nursing staff who will choose a career in PHC nursing. [source]


    Community health practitioner's practice guideline for a changing health care: Korean contribution

    JOURNAL OF CLINICAL NURSING, Issue 8 2009
    Il Sun Ko
    Aims and objectives., The specific aims of the study were (1) to identify community residents' health problems and community health practitioners' activities, (2) to explore community health practitioners' perception of the practice guidelines and (3) to provide recommendations for the development of a new practice guideline in the future. Background., Community health practitioners in Korea are recognised as a critical component of the public health workforce in rural areas. Community health practitioners are registered nurses with six months special training, who have the chief responsibility of delivering primary health care to remote or isolated communities. Although there has been numerous changes in focus of community health practitioners practice over the two decades, community health practitioners guidelines have never been updated since being first developed in 1981. Design., This investigation employed a cross-sectional survey and focus group interview. Methods., The samples included two different groups: 1003 community health practitioners participated in a survey and a group of 12 community health practitioners participated in a focus group interview. A measure of perception of the guideline was developed from Mansfield's work. Goolsby's criteria were revised and used to guide the focus group interview. Results., The participants recognised that the role of community health practitioners is in a process of transition and expect to use well developed guidelines that will allow an appropriate response to the needs of the community. Community health practitioners are generally supportive of practice guidelines although they report various contextual, social and resource barriers to the use of practice guidelines. Finally, the researchers have provided recommendations for the development of new community health practitioners practice guidelines. Conclusion., A newly developed community health practitioners guideline should assist in articulating new roles and responsibilities in the practice of community health practitioners and establish a foundation for knowledge, skills and training necessary for them to work independently. Relevance to clinical practice., New services made available for under-recognised health problems may be a direct outcome of newly developed guidelines. [source]


    Economic crisis and challenges for the Greek healthcare system: the emergent role of nursing management

    JOURNAL OF NURSING MANAGEMENT, Issue 5 2010
    VENETIA NOTARA MSc
    notara v., koupidis s.a., vaga e. & grammatikopoulos i.a. (2010) Journal of Nursing Management18, 501,504 Economic crisis and challenges for the Greek healthcare system: the emergent role of nursing management Background, Despite several reform efforts, the Greek health care system still faces problems related to misdistribution of trained health staff and finance between geographical areas. Aim, The objectives of the present study were to describe the current situation of the delivery of the healthcare service in Greece, to explore the basic implications of the economic crisis from a nursing management perspective and to examine future practices opening a debate in policy developments. Key issue, The principal finding of this study was the serious shortage of trained nurses, the imbalances in nursing personnel, an excess of doctors and the complete absence of a Primary Healthcare System in civil areas provided by general doctors. Conclusion, It is important that health care policy makers become aware and seriously consider rearranging the Health Care System to become more effective and efficient for the population (client). Special attention should be paid to strengthening areas such as primary health care, public health and health promotion in the direction of minimizing the demand of hospital services. Implications for nursing management, Any implementation of major health care reforms should consider seriously the role of the nursing management which formulates the substantial link between the health services and the patient. [source]