To use normalization process theory (NPT) to build a strategy for the implementation of goal-oriented care (GOC) in primary care in Flanders, Belgium.

GOC is a possible approach to more coordinated and integrated care and tailors care to patients’ personal life goals. The concept has gained interest among policy makers and researchers, but the main drivers for successful implementation are the primary healthcare professionals (PHCPs) who need to see added value of GOC in order to embed it into their daily practice. NPT, developed to understand the processes of implementing new ways of organizing care, offers a useful lens to understand adoption of GOC in primary care practice.

PHCPs (n = 131) who participated in a 2-hour community meeting on GOC were asked to complete the Normalization MeAsure Development survey. This 23-item survey is based on NPT and describes participants’ views about how an intervention would impact their work, their expectations about it, and whether it could become a routine part of their work.

The NPT constructs coherence (sense-making work) and cognitive participation (relational work) showed positive tendency toward implementation of GOC. The participants had an initial understanding on GOC and there was much interest in supporting and start working with this approach. The other constructs collective action (operational work) and reflexive monitoring (appraisal work) will need further efforts to trigger implementation. A common ground is needed to integrate GOC as a common practice which can be achieved by intensive interprofessional collaboration.

To describe the research project component of the BSc in Primary Health Care and to discuss the issues faced by students and faculty in attempting to complete a student-led research project.

Medical schools increasingly expect medical students to undertake research as part of intercalated BSc’s or in self-selected study modules. This research has historically been laboratory based, ‘piggybacking’ onto existing projects. Projects initiated by students themselves and studies in primary care or community settings are more unusual.

A qualitative study, based on interviews with students and examiners, triangulated with data from the peer review process and personal observations on the running of the course.

A London medical school, running an intercalated BSc in Primary Health Care.

We interviewed 24 of 26 students and two external examiners during the interview period of the study. Students successfully undertook research, from initial question through to publication. Overall, 90 dissertations were completed since 1997, of which half used a qualitative methodology (45/90). Ten projects have subsequently been published; there were also 16 conference presentations and 6 research letters. Themes from the interview data include: the students’ strong sense of project ownership, the difficulties of being a novice researcher, the difficulties posed by the research governance hurdles, the beneficial and for some students adverse impact (stress and coping with unsuccessful projects) and finally, the impact on their careers.

Students gain considerably from this learning process, not only by undertaking their own research, but they also gain in terms of acquisition of transferable skills such as critical appraisal and improved self-directedness. Project completion and publication rates suggest that programmes developing undergraduate initiated research projects can be as successful as those for other novice researchers. The student-led project is a fragile endeavour, but currently is sustainable.

With the unprecedented spread of the novel SARS-CoV-2 coronavirus, primary healthcare workers (PHCWs) are having to shoulder the increasing weight of this ongoing pandemic.

This study explored the rate and covariates of depressive symptoms among PHCWs in the Muscat governorate.

A cross-sectional online survey was conducted from 10 May to 10 June 2020 among PHCWs working in all primary healthcares across the Muscat governorate. Data on sociodemographic and risk factors of having at least one underlying physical health condition, a psychiatric history, family history of psychiatric disorders, and direct involvement with COVID-19 positive patients were sought. The Patient Health Questionnaire (PHQ-9) was then used to solicit the presence of depressive symptoms. Those with a cutoff point ≥10 were considered as showing depressive symptoms. Logistic regression was used to determine risk factors associated with depressive symptoms in PHCWs after adjusting for all sociodemographic factors.

A total of 432 (72%) out of 600 PHCWs with an average age of 39.2 years (SD = 7.8 years) ranging between 25.0 and 75.0 years responded to the survey. There were more females (n = 281, 65.3%) than males, and more than 45% (n = 195) of them were physicians. Additionally, more than 78% (n = 338) had been in contact with COVID-19 patients. There was a significant association between different age groups and profession (P < .001), having at least one underlying physical health condition (P = 0.001) and depressive symptom status (P = 0.038). A total of 78 out of the 423 subjects (18.1%) were considered to have depressive symptoms. After adjusting for all factors, the logistic regression model showed that an age of 34 years or below (OR = 2.079, P = 0.021) and having at least one underlying physical health condition (OR = 2.216, P = 0.007) were factors contributing significantly to depressive symptoms among the PHCWs.

The objective of this study was to examine young adults’ healthcare utilisation and its possible association with health literacy.

Many countries struggle with insufficient accessibility at emergency departments (EDs) and primary healthcare centres (PHCs). Young adults, aged 20–29 years old, account for a substantial number of unnecessary doctor visits where health literacy could be an explanatory factor.

This study incorporated a combined retrospective and cross-sectional study design with analysis of registry data, including all registered outpatient doctor visits between 2004 and 2014 (n = 1 086 432), and strategic sample questionnaire data (n = 207), focusing on socio-demographics, symptoms and information-seeking behaviour. Mean differences between first-year and last-year doctor visits for each age group were calculated using registry data. Fischer’s exact test was applied to questionnaire data to analyse group differences between ED and PHC visitors as well as between patients with sufficient health literacy and insufficient health literacy. Binary logistic regression was used to investigate covariation.

Healthcare utilisation has increased among young adults during the past decade, however, not comparatively more than for other age groups. ED patients (n = 49) compared to PHC patients (n = 158) were more likely to seek treatment for gastrointestinal symptoms (P = 0.001), had shorter duration of symptoms (P = 0.001) and sought care more often on the recommendation of a healthcare professional (P = 0.001). Insufficient/problematic health literacy among young adults was associated with having lower reliance on the healthcare system (P = 0.03) and with a greater likelihood of seeking treatment for psychiatric symptoms (P = 0.002).

Young adults do not account for the increase in healthcare utilisation during the last decade to a greater extent than other age groups. Young adults’ reliance on the healthcare system is associated with health literacy, an indicator potentially important for consideration when studying health literacy and its relationship to more effective use of healthcare services.

This article draws on the poverty and access to health care framework to explore the barriers to access and utilization of primary health care among aged indigents under the Livelihood Empowerment Against Poverty Programme (LEAP) in Ghana.

Although many developing countries have made progress in extending primary health care to their populations following the Alma-Ata Declaration of 1978, the establishment of the Millennium Development Goals, and the Sustainable Development Goals (SDGs), barriers remain pervasive, particularly among vulnerable population groups. Previous studies have hardly paid in-depth attention to this important indicator for measuring progress toward achieving SDG 3.

To this end, we conducted a case study of access to health care services and utilization among aged indigents enrolled on the LEAP programme in the Daffiama Bussie Issa District of the Upper West. We collected and analyzed qualitative data from indigents aged 65 years and above, health care providers, and staff of the LEAP and the National Health Insurance Scheme (NHIS).

Our analysis found geographic inaccessibility of health care, high costs of drugs and related services, exclusion of essential services from NHIS benefits package, and irregular transfer of cash to negatively influence access and utilization of health care among aged LEAP beneficiaries in the district. In addition to the need to strengthen the economy, provide health infrastructure and human resources for health in rural areas, the government needs to review the beneficiaries’ bimonthly stipends to reflect the daily minimum wage, eliminate the delay in payments, and review the benefits package of the NHIS to include essential services and medical devices commonly used by aged people. Yet implementing these recommendations has affordability implications that require innovation to mobilize additional resources and create the desired fiscal space and institutions that can sustainably implement universal coverage programmes such as the LEAP.

To identify the reasons why patients with minor complaints choose emergency departments (EDs) as a first contact of care and whether dissatisfaction with primary care services influences their decisions.

In this study, a self-completed survey called EUROPEP was given to 535 outpatients who were admitted to the XXXXX Hospital in Bursa and examined in the green zone in July 2015. Patients were asked about their complaints and why they preferred EDs as a first contact of care.

EDs were the first contact of care in 87.8% of cases. In all, 9% of patients registered to family physicians who were working outside the city of Bursa. There was no relationship between patient satisfaction and the number of previous visits to EDs in last 12 months (P=0.09). The main reasons for admitting to the emergency services were feeling excessive pain (20.4%), perception of urgency (14.5%) and that the family doctor services were closed outside working hours (13.2%). The mean patient satisfaction with family practice offices was calculated to be 68.1%.

The frequency of admission to EDs as a first contact of care was extremely high in the absence of a referral system. Patients who did not have family doctors in the settlement where they live put an extra burden on the EDs. Overall, patient satisfaction with their GPs did not influence the number of visits to EDs but accessibility remains a big challenge.

This study aimed to explore the extent to which health visitors who trained and qualified in both Greater London and the South West of England between September 2011 and January 2016 were employed in health visiting posts and have remained in the profession.

In 2011, the UK Government launched the Health Visitor Implementation Plan ‘A Call to Action’ (Department of Health, 2011) to develop the health visitor workforce by training 4200 health visitors over a four-year period. By April 2015, 4000 additional health visitors were trained, but the total workforce has since fallen back to pre-Implementation Plan size.

Data were collected using a survey, completed online by participants. All participants had undertaken a health visitor education programme at one of two participating universities. The survey was distributed in January 2017 and completed by 180 individuals. Quantitative data were analysed using SPSS; association was assessed using individual chi-square tests or Fisher’s exact test. Free-text responses were thematically analysed.

Most (153; 87%) participants were still working as health visitors. Length of time spent working in the community prior to completing health visitor training was associated with staying in the role ( χ2 (with Fisher’s exact test = 7.998, P = .027). Current pay was associated with attrition from the health visitor workforce ( χ2 (with Fisher’s exact test) = 67.559, P < .001.). The majority who had left the health visitor role were on higher pay bands in their new post compared to those that had stayed (12; 60%). Bronfenbrenner’s (1979) theory of socio-ecological development was used as a framework to interpret the results. While participants made an active choice to join the profession, leaving was influenced more by factors outside their control. To influence health visitor retention, both local and strategic changes are required.

Engagement of general practitioners (GPs) and recruitment of patients are ever present problems in primary care studies. This paper seeks to demonstrate that electronic prompts represent one method of easing the burden on GPs to recruit individual patients to studies and also provide the opportunity to collect research data during a normal consultation.

Older adults consulting for non-inflammatory musculoskeletal pain from five general practices in Cheshire were recruited to a prospective cohort study (the PROG-RES study). Recruitment of patients was aided by a computer prompt during relevant consultations. When triggered by an appropriate Read code, a pop-up template appeared on the consultation screen prompting the GPs to record the answers to seven brief questions. A self-complete questionnaire was mailed to patients who had completed templates by the Keele GP Research Network team and permission was sought to access their medical records. A feasibility study suggested that the potential number of activated templates in the practice within four months would be 636.

The 44 GPs completed 650 electronic templates during the four-month recruitment period. Almost 40% of recruitment was within four weeks and greater than 95% of recruitment was within 16 weeks. Practices A–D completed electronic templates at a similar rate (1.61–1.86 templates per 1000 patients), although practice E completed templates at a lower frequency (0.76) due to internal difficulties. Completion of individual items ranged from 98% to 83% and completion of all seven questions was recorded in 63% of patients; 4% of patients had three or fewer responses recorded.

Templates activated by appropriate codes in the GP consultation can facilitate recruitment to observational studies in primary care. It is possible to collect high-quality research data within a normal consultation. This may be a model for use in future studies in primary care.

Lack of access to primary care providers (PCPs) is a significant hurdle to receiving high-quality comprehensive health care and creates greater reliance on emergency departments and walk-in clinics.

We conducted a rapid review and analysis of the literature that discusses approaches to increasing access to continuous care for patients with no PCP (‘unattached patients’).

Five distinct themes across 38 resources were identified: financial incentives for patients and providers, health care organization, policy intervention, virtual care and health information technology (HIT), and medical education. Approaches that increased attachment were primary care models that combined two or more of these and reflected the Patient’s Medical Home (PMH) model.

Although there are individual initiatives that could allow for temporary relief, long-term and community-wide success lies in designing models of primary care that use multiple tools, meet the needs of the community, and are supported by regional, provincial, and national policies.

In the crowded field of leadership research, Indigenous leadership remains under-researched. This article explores the Leadership Model of an Aboriginal Community Controlled Primary Health Care Organisation providing services to the Yolngu people of remote northern Australia: the Miwatj Health Aboriginal Corporation (Miwatj).

The limited research which does exist on Indigenous leadership points to unique challenges for Indigenous leaders. These challenges relate to fostering self-determination in their communities, managing significant community expectations, and navigating a path between culturally divergent approaches to management and leadership.

Guided by Indigenous methodology and using a mixed methods approach, semi-structured interviews, self-reported health service data, organisational and publicly available documents, and literature were analysed using a framework method of thematic analysis to identify key themes of the Miwatj Leadership Model.

The Miwatj Leadership Model is underpinned by three distinctive elements: it offers Yolngu people employment opportunities; it supports staff who want to move into leadership positions and provides capacity building through certificates and diplomas; and it provides for the physical, emotional, and cultural wellbeing of all Yolngu staff. Furthermore, the model respects traditional Yolngu forms of authority and empowers the community to develop, manage and sustain their own health. The Miwatj Leadership Model has been successful in providing formal pathways to support Indigenous staff to take on leadership roles, and has improved the accessibility and acceptability of health care services as a result of Yolngu employment and improved cultural safety.

Translating the Miwatj Leadership Model into other health services will require considerable thought and commitment. The Miwatj Leadership Model can be adapted to meet the needs of other health care services in consideration of the unique context within which they operate. This study has demonstrated the importance of having a formal leadership model that promotes recruitment, retention, and career progression for Indigenous staff.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major predisposing risk factor for stroke. Current UK guidelines propose stroke-risk stratification of AF patients. Anticoagulation with warfarin is recommended for high risk patients, whereas treatment with aspirin alone is advised for those at low risk. The aim of this audit was to review practice at our institution and ascertain if guidelines on AF treatment were being followed.

A retrospective review of all patients diagnosed with non-valvular AF in June 2010 was undertaken. Patient records were reviewed to collect demographic and co-morbidity data relevant to stroke risk stratification. This was subsequently used to stratify patients according to stroke-risk using the CHADS2 scoring system. The use of anticoagulation and anti-platelet medication as well as any documented reasons for the omission of anticoagulation in high risk patients was noted.

The prevalence of non-valvular AF in our practice population was 1.5% (151/10,155); 70% (105/151) of AF patients were found to be at high risk of stroke; 36% (38/105) of high risk patients were not on anticoagulation and the majority (58%) of these patients had no clear reason documented for the omission of warfarin. Of the 15 patients at low risk of stroke, 12 (80%) were on warfarin. Seven (4.4%) of the 151 AF patients were on both warfarin and aspirin and six (4%) were on neither medication. The commonest documented reasons for omission of warfarin in the high risk group were dementia and a history of gastrointestinal bleeding.

The lack of documentation on withholding a proven beneficial treatment in high risk patients could potentially leave physicians open to medico-legal scrutiny. Maintaining low risk patients on anticoagulation may expose them to unnecessary risk. We recommend the use of automated audit tools designed to improve compliance with national guidelines.

Maternal mental health problems affect up to 20% of women, with potentially deleterious effects to the mother and family. To address this serious problem, a Maternal Mental Health Program (MMHP) using a shared care approach was developed. A shared care approach can promote an efficient use of limited specialized maternal mental health services, strengthen collaboration between the maternal mental health care team and primary care physicians, increase access to maternal mental health care services, and promote primary care provider competence in treating maternal mental health problems.

The purpose of this research was to evaluate the impact of a MMHP using a shared care approach on maternal anxiety and depression symptoms of participants, the satisfaction of women and referring physicians, and whether the program met the intents of shared care approach (such as quick consultation, increased knowledge, and confidence of primary care physicians).

We used a pre and post cross-sectional study design to evaluate women’s depression and anxiety symptoms and the satisfaction of women and their primary care health provider with the program.

Depression and anxiety symptoms significantly improved with involvement with the program. Women and physicians reported high levels of satisfaction with the program. Physician knowledge and confidence treating maternal mental health problems improved.

Shared care can be an effective and efficient way to provide maternal mental health care in primary health care settings where resources are limited.

To investigate the effectiveness of eTansiyon smartphone application in blood pressure control in patients with hypertension.

Global prevalence of hypertension and the burden of chronic illness care, especially in primary care, are increasing in world. We have developed eTansiyon to ensure the continuity of patient-physician relationship, so it may help to improve the lifestyle of patients with hypertension, increase their adherence to treatment and achieve the target blood pressure.

This study was a non-randomized controlled study. The sample was selected by random sampling method among the patients registered in 6 Family Health Units (FHUs). Randomization was performed at the FHU level; the units were randomized to 4 control group (CG) and 2 intervention group (IG), so that randomization in this study was 2:1. Both groups were followed up for at least four months. In addition to CG, IG were provided to use eTansiyon. Obtained data were analysed to evaluate differences between groups at the beginning and end of the study, intra-group changes after follow-up and interaction between groups and follow-up period.

The study was performed with 124 patients in CG and 61 patients in IG. At the end of the study, the average systolic blood pressure/diastolic blood pressure (SBP/DBP) of office and home was significantly lower in IG compared to CG (P < 0.001, MD 9.5 mmHg; P = 0.007, MD 3.8 mmHg; P < 0.001, MD 10.6 mmHg; P < 0.001, MD 4.8 mmHg, respectively), and it was found that the proportion of people with target blood pressure in IG was significantly higher than CG (P < 0.001, 49.2%(n = 30) and 22.6%(n = 28), respectively). Repeated measures ANOVA and generalized estimating equations results showed that follow-up period and interaction between groups were significant in terms of office and home SBP/DBP and target blood pressure level during follow-up period (P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.024, respectively).