Front-line NHS staff undertake small research projects to answer questions about local patients and services, but these projects often face considerable challenges. This paper reports on one such project.

The study used structured interviews in order to find out about the knowledge of nutrition among Bangladeshis using an NHS Walk-in Centre.

Time constraints posed considerable difficulties in progressing and completing the study; flaws in the methodology emerged; and underpinning assumptions about health promotion and ethnic minority health beliefs were open to challenge.

Despite this, some findings were valuable and have considerable potential as a stimulus to critical thinking among practitioners about their own attitudes, as well as raising issues that future research would find it useful to address.

This study aimed to evaluate the feasibility of implementing community pharmacy-based tuberculosis-directly observed treatment (TB-DOT) in Malaysia.

Tuberculosis (TB) eradication is one of the top priorities in the public health agenda in Malaysia. While public-private mix (PPM) initiatives have been launched, community pharmacists remain undervalued assets in TB management.

A two-phase mixed-methods study targeting community pharmacists was conducted in Malaysia between March and October 2021. The first phase was an online self-administered survey developed according to the Consolidated Framework for Implementation Research (CFIR). The second phase was a semi-structured interview to allow deeper understanding on the quantitative results. Quantitative data were analysed using descriptive analysis while qualitative data were analysed using thematic analysis with a semi-inductive approach. The data were triangulated to enhance comprehensiveness and credibility of the findings.

The survey was completed by 388 community pharmacists, and 23 pharmacists participated in the interview. Most community pharmacists indicated their willingness to serve as TB-DOT supervisors (70.1%). Qualitative results supported the findings. Community pharmacy-based TB-DOT service was perceived as an avenue to improve TB management and outcomes and to enhance the professional role of pharmacists in TB service at primary care settings. This was also perceived as a feasible intervention with the potential to strengthen the National TB Control programme. This initiative needs be reinforced with adequate support from the public healthcare sector for a strong partnership in ensuring success.

This study aimed to assess the consistency and replicability of these process measures during provision of the Italian Medicines Use Review (I-MUR).

Medication review is a common intervention provided by community pharmacists in many countries, but with little evidence of consistency and replicability. The I-MUR utilised a standardised question template in two separate large-scale studies. The template facilitated pharmacists in recording medicines and problems reported by patients, the pharmaceutical care issues (PCIs) they found and actions they took to improve medicines use.

Community pharmacists from four cities and across 15 regions were involved in the two studies. Patients included were adults with asthma. Medicines use, adherence, asthma problems, PCIs and actions taken by pharmacists were compared across studies to assess consistency and replicability of I-MUR.

The total number of pharmacists and patients completing the studies was 275 and 1711, respectively. No statistically significant differences were found between the studies in the following domains: patients’ demographic, patients’ perceived problems, adherence, asthma medicines used and healthy living advice provided by pharmacists. The proportion of patients in which pharmacists identified PCIs was similar across both studies. There were differences only in the incidence of non-steroidal anti-inflammatory drug use, the frequency of potential drug-disease interactions and in the types of advice given to patients and GPs.

The use of a standardised template for the I-MUR may have contributed to a degree of consistency in the issues found, which suggests this intervention could have good replicability.

General practitioners (GPs) do not systematically include preventive recommendations in their practice, and some characteristics of health care organization are associated with more systematic prevention. But the characteristics of health care organization may act in a nonuniform manner depending on the type of preventive care. Thus, one characteristic can be positively associated with one type of preventive care and negatively associated with another. Our aim was to investigate the association between health care organization in general practice and different areas of preventive care (immunization and addiction prevention), in search of nonuniform associations.

We used a representative survey of 1,813 French GPs conducted in 2009. Four preventive care practices were studied: immunization through flu and HPV vaccination, and prevention of addictive behaviors concerning tobacco and alcohol use.

Characteristics of GPs’ health care organization and the social context of their practice were collected (spatial accessibility to GPs and socioeconomic level of the area of practice). We constructed mixed models to study associations and interactions between the organization variables and preventive care.

Four out of five characteristics of GPs’ organization have uneven impacts on different types of preventive care (p-interaction < 10-4). For example, number of daily consultations is associated with better immunization prevention but with poorer prevention counseling in addictive behaviors. In contrast, working with digital medical files is uniformly associated with both types of preventive care (OR = 1.29 [1.15–1.45]; P < 10-4).

An approach centered on specific types of preventive care should help deepen our understanding of prevention and possibly help to identify a new typology for preventive care.

With the global spreading of Coronavirus disease (COVID-19), many primary care medical workers have been infected, particularly in the early stages of this pandemic. Although extensive studies have explored the COVID-19 transmission patterns and (non-) pharmaceutical intervention to protect the general public, limited research has analysed the measures to prevent nosocomial transmission based upon detailed interpersonal contacts between medical staff and patients.

This paper aims to develop and evaluate proactive prevention measures to contain the nosocomial transmission of COVID-19. The specific objectives are (1) to understand the virus transmission via interpersonal contacts among medical staff and patients; (2) to define proactive measures to reduce the risk of infection of medical staff and (3) evaluate the effectiveness of these measures to control the COVID-19 epidemic in hospitals.

We observed the operation of a typical primary hospital in China to understand the interpersonal contacts among medical staff and patients. We defined effective distance as the indicator for risk of transmission. Then three proactive measures were proposed based upon the observations, including a medical staff rotation system, the establishment of a separate fever clinic and medical staff working alone. Finally, the impacts of these measures are evaluated with a modified Susceptible-Exposure-Infected-Removed model accommodating the situation of hospitals and asymptomatic and latent infection of COVID-19. The case study was conducted with the hospital observed in December 2019 and February 2020.

The implementation of the medical staff rotation system has the most significant impact on containing the epidemic. The establishment of a separate fever clinic and medical staff working alone also benefits from inhibiting the epidemic outbreak. The simulation finds that if effective prevention and control measures are not taken in time, it will lead to a surge of infection cases in all asymptomatic probabilities and incubation periods.

This study aimed to (i) identify community health workers’ (CHWs) perceived satisfaction for maternal and neonatal health services, with respect to (1) socio-demographic characteristics; (2) coronavirus preparedness; (3) coronavirus responsiveness; and (4) employee satisfaction and (ii) investigate the interplay among study variables to identify the role of direct effects and mediation.

Women CHWs are salient providers for maternal and neonatal services at the primary level, especially in conservative regions. Service delivery is a valuable indicator for mother and newborn wellbeing. There is need for empirical evidence to understand how CHWs may be supported in delivering maternal and neonatal health services during pandemics.

Bivariate regression was used to identify the lower odds for CHWs’ perceived satisfaction for maternal and neonatal health services. In addition, structural equation modeling was used to investigate if coronavirus responsiveness and employee satisfaction as mediating variables influence the relationship between coronavirus preparedness and maternal and neonatal health services. Data were collected telephonically from 350 CHWs. The sample was representative of 35 districts of Punjab, which is the most populated province in the country.

We found thirty predictors with respect to coronavirus preparedness, coronavirus responsiveness and employee satisfaction which contribute to lower odds of satisfaction for maternal and neonatal health services. We also found that coronavirus preparedness has a direct effect on maternal and neonatal health service satisfaction (β = .242, P < .001) and an indirect effect on maternal health satisfaction (β = .242, P < .001) via the mediation of employee satisfaction. We conclude with four critical recommendations to support CHWs in delivering optimal services, comprising of education and training, operational support, public acceptance, and employee support and benefits. The findings are important for the planning of primary health services and governance support for CHWs and poor women clients in Pakistan and other developing countries.

To define the predictive value of clinical diagnosis of chronic obstructive pulmonary disease (COPD) or suspected COPD in primary care patients with spirometric criteria for diagnosis.

The diagnosis of COPD is usually made clinically but often not confirmed by diagnostic testing. Recent initiatives have called for universal spirometry testing in primary care to diagnose and monitor such patients the implications of this policy on diagnostic accuracy are not as yet known.

Retrospective comparative analysis of 677 consecutive primary care referrals to a district general hospital lung function laboratory for spirometry, March 1998 to December 2006.

Five hundred and three of 677 patients referred for open access spirometry had a primary care clinical diagnosis or suspected diagnosis of COPD. When compared with NICE spirometric criteria for diagnosis of COPD, 141 patients (28%) had normal spirometry, 46 (9%) had reversible airflow obstruction and 14 (3%) a restrictive pattern of spirometry. The positive predictive value of a primary care clinical diagnosis of COPD was 0.62 for patients referred for assessment of severity and 0.56 for those referred for diagnostic testing. Clinical suspicion of COPD in this sample was not confirmed by spirometry in a high proportion of referred patients. The introduction of the widespread use of spirometry for confirmation of primary care clinician made COPD diagnosis have important implications for both individual patients and primary care service planning.

Long-term urinary catheters are problematic and burdensome for patients, carers and health services. Nursing practice to improve the management of long-term urinary catheters has been held back by a lack of evidence to support policy and practice. Little is known about who uses a catheter long term and the resources and costs needed for their management. Understanding these costs will help to target innovations to improve care. There have been no substantial innovations to urinary catheters or their management recently and no publications to characterise users and costs.

To describe long-term catheter users and explore catheter-related service use and costs in England.

Descriptive information on the characteristics of catheter users and their use of services was obtained from: General Practice records (n = 607), district nursing records (n = 303), questionnaires to patients (n = 333) and triangulated, 2009–2012. Annual service costs (British pounds 2011) were computed.

Most catheter users (59.6%) were men, nearly three-quarters (71.2%) were over 70 years and 60.8% used a urethral catheter. Women tended to be younger than men and more likely to use a suprapubic catheter. The services used most frequently over 12 months were general practitioner (by 63.1%) and out of hours services (43.0%); 15.5% accessed Accident and Emergency services for urgent catheter-related care. Hospital use accounted for nearly half (48.9%) of total health service costs (mainly due to inpatient stays by 13.6% of participants); catheter supplies/medications were next most costly (25.7%). Half of all costs were accounted for by 14.2% of users. The median annual cost of services used was £6.38, IQR: £344–£1324; district nursing services added approximately a further £200 per annum.

Finding better ways to reduce catheter problems (e.g. blockage, infection) that cause unplanned visits, urgent or hospital care should be a priority to improve quality of life for long-term catheter users and reduce health service expenditure.

This study aims to describe how the pharmaceutical services are performed in Primary Healthcare Centers of the Brazilian Public Health System in a large city. Background: There is extensive international discussion about the role of pharmacists in health care teams, particularly in Primary Health Care (PHC). However, in Brazil, there is still no consensus on what services the pharmacist should perform in multidisciplinary teams in PHC.

This study used mixed methods research, and it was conducted with 200 pharmacists who work in PHC Centers of the public health system in São Paulo. The study was conducted using a focus group and an online survey, and qualitative and quantitative data were obtained.

The analysis of the data from the focus group showed two central themes: (i) pharmaceutical services go beyond medicines and (ii) the contributions of the pharmacist to a multidisciplinary team work in PHC. The survey explored 29 services provided by pharmacists, 7 of which were provided daily. It is important to emphasize that pharmacists do not differentiate the relevance attributed to services considered clinical from those that are managerial or more related to access to medicines. This is an opportunity to develop their teamwork skills. Hence, it is necessary to consolidate the professional identity of the pharmacist and to organize their work processes in a multidisciplinary team. PHC is a space that allows a wide development of pharmaceutical services.

Increased number of preventable hospitalizations (PHs) for ambulatory care sensitive conditions (ACSCs) represents less efficiency and low access to outpatient and primary health care, leading to waste of health system resources.

The purpose of this study is to assess the quality of outpatient and primary health care using the rate of PHs for ACSCs and to estimate the economic burden of ASCS before and after the implementation of the health transformation plan (HTP) in Iran.

This research was a before–after quasi-experimental study. The study population included all patients hospitalized in the largest general hospital of Kurdistan province with five diseases such as asthma, diabetes, hypertension, congestive heart failure, and chronic obstructive pulmonary disease in 2014 (before the implementation of the HTP) and 2015 (after the implementation of the HTP). Data were analyzed by SPSS v.20 using Chi-square test.

Total number of hospitalizations before and after the implementation of the HTP was 1501 and 1405, respectively. Moreover, the proportion of PHs in all types of the hospital admissions before and after the implementation of the HTP was 47% and 49%, respectively. There was no statistically significant difference between the number of PHs before and after the HTP. In total, PHs imposed 885 798 US$ and 9920 bed-days on health system before and after the implementation of the HTP.

Despite the previous expectations of policy makers for improving quality, efficiency, and access to primary health care through implementation of the HTP, proportion of PHs is considerable and it imposes a lot of costs and bed-days on the health system both before and after the HTP.

UK health policy identifies partnership working as fundamental to tackling health inequalities. Related to this is the development of a multi-disciplinary public health workforce, including an increase in the public health role of primary care nurses. Within this policy context, a primary care trust in the north of England established a community health team (CHT) in September 2005 to improve intra- and inter-agency working for public health. The Clinical Microsystems (CMS) framework informed the process of development, an approach not previously applied to public health.

This paper describes an evaluation of the CHT and presents the key lessons learnt in terms of what worked and did not work in the context of the CMS framework.

Participants were members and wider stakeholders of the CHT from three professional groups: individuals holding relevant strategic posts in the Public Health and Nursing Directorates within the Primary Care Trust, health visitors and school nurses, and voluntary sector staff. Focus group (n = 9 focus groups) and postal questionnaire (n = 21) data were collected at baseline, 6 and 12 months post-implementation. Participants’ views on the implementation of the CHT were explored within the ‘five Ps’ (purpose, population, people, processes and patterns) of the CMS framework.

Six themes emerged from the focus group data that illustrated key issues for the implementation of the CHT: ‘agreeing the focus,’ ‘strong leadership,’ ‘the challenge of communication,’ ‘managing workloads and new ways of working,’ ‘success of the CHT’ and ‘outside influences.’ Communication and heavy workloads were identified as key barriers to the success of the CHT in the questionnaire data. These data highlight the complex and evolving nature of public health partnership working and identify important issues that might usefully be considered in future initiatives of this kind.

To determine the presence of cardiovascular (CV) risk (CVR) factors in university students and evaluate how these factors are affected from the knowledge, attitudes, and habits of the individuals regarding healthy lifestyle.

Starting from early ages, lifestyle habits such as lack of physical activity, unhealthy eating, and inappropriate drug use increase CV and metabolic risks of individuals.

In April–May 2018, sociodemographic characteristics of 770 undergraduate students, in addition to their knowledge, attitudes, and habits regarding their nutrition and physical activity status were obtained through face-to-face questionnaires. CVR factors were determined according to blood pressure, blood glucose, total cholesterol levels, and anthropometric measurements. Collected data were compared by CVR factor presence (CV[+] or CV[−]) in students.

The mean age of the participants was 22.3 ± 2.6 years. 59.6% were female and 71.5% were students of non-health sciences. In total, 274 individuals (35.9%) belonged to CV(+) group (mean risk number: 1.3 ± 0.5) with higher frequency in males (42.1% versus 31.6%, P < 0.05). The most common CVR factors were smoking (20.6%), high total cholesterol (7.5%), and hypertension/high blood pressure (6.0%). 15.5% of the participants regularly used at least one drug/non-pharmaceutical product. 11.3% complied the Mediterranean diet well. 21.9% of CV(+) stated consuming fast food at lunch compared to 14.3% of CV(−) (P < 0.05). 44.6% stated exercising below the CV-protective level.

This study showed one-third of university students was at CVR, independent of their sociodemographic characteristics. Furthermore, the students appear to perform below expectations in terms of nutrition and physical activity. Extensive additional measures are needed to encourage young individuals for healthy nutritional and physical activity habits.

Interventions that increase participation in physical activity and positive dietary changes may improve the health of the community through modifying the lifestyle contribution to preventable disease. However, previous evaluations have identified concerns about inequitable and unsustainable uptake, adherence and retention within healthy lifestyle schemes.

The intervention evaluated here was designed to be a 12-week intervention for participants, offering free testing of physiological indicators of health, one-to-one health advice and a range of exercise, activity and cookery classes, at no or reduced cost, at local venues throughout the community. This paper reports the findings from a small qualitative study undertaken to explore the experiences and reflections of those who took part in the intervention to different extents, including those who fully and partially participated as well as those who dropped out or declined to take part.

Sixteen respondents took part in semi-structured interviews (5 male, 11 female; 8 black, 8 white; age range 25–85).

The findings suggest that participants assessed the healthy lifestyle intervention in terms of how well it met their pre-existing needs and opportunities for change, and that they selected the aspects of the scheme that suited them, interested them and were perceived as delivering salient results. There is also evidence for a stronger role of perceived support in influencing uptake and maintenance of lifestyle changes, and that support was conceptualised by participants as one of the services offered by the scheme. Perceived support and related perceptions of reliance on the scheme to sustain lifestyle changes also suggested that in some cases full adherence to a scheme is not as likely to produce long-term adherence to lifestyle changes as compared to partial, but more realistic adherence and smaller lifestyle changes. Implications for delivering and evaluating healthy lifestyle interventions are also discussed.

Reports of work absence usually come from self-report or company absence records; however, these records are limited to just one company. Electronic recording of sickness certification in primary care medical records may provide an alternative source of data, but its relation to other sources of sickness absence information is unknown. Comparing general practitioner electronic sickness certification records with self-reported work absence would enable the comparability of these electronic records to be established.

To investigate the comparability of electronic medical records of sickness certification in primary care, with self-reported work absence.

Analysis included 292 primary care low-back pain consulters who consented to medical record review. A within-group design was used to match electronic records of sickness certification with self-reported sickness absence.

Overall 95% of the electronic medical records of sickness certification matched with self-reported absences; 96% in employed consulters and 95% in unemployed consulters. In all, 94% of employed participants were a direct match, 2% a consistent match and 4% a mismatch. Including consistent matches increased matching to 97% in employed consulters and to 100% in unemployed consulters. Electronic records of sickness certification in general practice are a useful method of analysing sickness absence in the population, as they are comparable with other sources of data. Additionally, electronic records of sickness certification will allow the investigation of sickness absence where data from one company are too limited and self-report is not available or unreliable. To facilitate the use of electronic medical records of sickness certification, data need to be accurately recorded and evaluated or audited to ensure completeness and validity. Furthermore, methods should be developed to ensure straightforward linkage between sickness certification records and other data held on the electronic medical record.