The aim of this study is to investigate whether individuals diagnosed with chronic diseases associated with the metabolic syndrome (MetS) receive favorable quality of care processes in the primary care setting relative to other individuals with and without chronic diseases.

Data from the 2010 Brazos Valley Health Status Assessment (BVHSA) (n = 3964) were analyzed. Individuals diagnosed with chronic diseases that are collectively associated with a diagnosis of MetS, namely obesity, diabetes, high cholesterol, and hypertension, were characterized as a group (ie, analytic sample, n = 168). Clinical guidelines were utilized to identify indicators representing the quality of care processes received by these individuals during visits with their health-care provider.

Measures of quality of care processes were analyzed relative to a comparator group comprising individuals with no chronic diseases and an alternative test group comprising those diagnosed with other chronic diseases (eg, arthritis, depression, and cancer among others) using multinomial and binary logistic regression.

Physician communication of critical issues such as diet, stress, and weight status was statistically more pronounced in the analytic sample relative to the comparator group. However, differences in physician communication about physical activity were not statistically significant relative to the comparator group (OR = 1.26, P = 0.533). Differences in testing of cholesterol (OR = 0.94, P = 0.743) and blood pressure (OR = 1.16, P = 0.619) were also not statistically significant relative to the comparator group. Individuals who may have MetS generally receive favorable quality of care processes from their health-care provider, but opportunities exist to enhance provider communication about physical activity, and to possibly improve frequency of cholesterol and blood pressure testing.

This study was part of a major project studying the metabolic syndrome in Finnish men. The final sample composed of 273 (39%) men who voluntarily completed the Health Behaviour Questionnaire.

To identify key determinants of health behaviour and health beliefs in middle-aged men, and to analyse how they are associated with underlying health covariates.

A stepwise logistic regression model was used to estimate the adjusted odds of the outcome by socio-demographic, health-behaviour, health-belief and clinical factors.

Five models were developed: (1) use of medications, (2) alcohol consumption, (3) self-rated health status, (4) burnout, and (5) motivation to change unhealthy behaviours. Existing illness or injury and occupation had the strongest associations with medication use, in which industrial workers were more likely to use medications than office personnel. A positive association was found between alcohol counselling by family members and less use of alcohol. Lack of illness or injury, good dental health, and normal waist circumference had the strongest associations with perceived good health. Depression and insomnia were the most significant predictors for burnout. Men who exercised 4–7 times a week, or who used alcohol infrequently or not at all, were over two times more likely to be motivated than inactive men.

Many relevant predictors that were significantly associated with the selected key determinants of health behaviour and health beliefs of middle-aged men were found in this study. The promotion of regular physical activity and healthy lifestyles among middle-aged men is currently one of the most important priorities of preventive work in primary health care. More gender-specific studies are needed to obtain a deeper understanding regarding men’s health issues.

Studying the effect of primary health care development when simultaneously implemented with health insurance schemes assesses effectiveness and use of health care services and gives us insight on how to develop such interventions in different countries.

To analyze the impact of health insurance and the family physician program on total hospitalizations, and the relation between avoidable hospitalizations and access to family physicians among the rural population in Iran.

We conducted an interrupted time series (ITS) analysis of monthly hospitalization rates between the years of 2003 and 2014 to assess the immediate and gradual effects of these reforms on total hospitalization rates in the rural areas of Tehran province. In addition, we used a sample of 22 570 hospitalizations between 2006 and 2013 to develop a logistic regression model to measure the association between access to a family physician and avoidable hospitalizations.

ITS analysis showed that there was an immediate increase of about 1.96 hospitalizations per 1000 inhabitants (P<0.0001, CI=1.58, 2.34) hospitalization rates after the reforms. This was followed by a significant increase of about 0.089 per 1000 inhabitants (P<0.0001, CI=0.07, 0.1). Hospitalization increase continued up to four years after the policy implementation. Following that, hospitalization rates decreased among the rural population (a decrease of 0.066 per 1000, P<0.0001, CI=−0.084, −0.048). Studying the hospitalizations that occurred between 2006 and 2013 showed that there were 4106 avoidable hospitalizations from among a sample of 22 570 hospitalizations. Results of logistic regression models including gender, age and access to family physician variables showed that there was no statistical relation between access to a family physician and avoidable hospitalizations.

Reforms had access effect and caused increased hospital services uses in people with unmet needs. Also the reforms did not decrease avoidable hospitalizations, and therefore had no efficiency effect.

This study aimed to compare the prevalence of stroke risk factors among people with a parental history of stroke to those in a control group of individuals, of similar age, gender and social class, with no parental stroke history.

Parental stroke increases an individual’s risk of stroke, but little is known of the potential value of using this information in targeted screening for primary prevention in general practice.

We sent questionnaires to 300 randomly selected individuals aged 40–65 years, in each of 11 different general practices in Northern Ireland. Among 1061 responses received within six weeks, 332 reported a parental history of stroke (31.3%). We matched respondents with (cases) and without (controls) a parental history of stroke on characteristics of age, gender and socioeconomic status. Matched pairs were invited to attend a consultation at which their diet and exercise habits were assessed using validated questionnaires and height, weight, blood pressure and serum lipids and glucose were measured.

Matched data were available for 199 case–control pairs (398 individuals). Mean systolic and diastolic blood pressures were significantly higher in cases than in paired controls (systolic 146.3 versus 140.6 mmHg (P < 0.01); diastolic 87.7 versus 85.0 mmHg (P = 0.014)). Cases consumed more alcohol than their paired controls (13.8 versus 10.1 U/week (P < 0.01)), but their measures of body mass index, lipids, diabetes, diet and exercise did not differ significantly. The results of this study suggest that screening offspring of patients with stroke in respect of blood pressure has potential value in identifying people likely to benefit from primary prevention, but do not support the adoption of a targeted screening strategy for other commonly cited stroke risk factors.

This paper reports on a project conducted between 2008 and 2011 that was established to allow eight Australian Indigenous men who had been in prison to tell their stories of incarceration.

The Shed in Western Sydney, NSW, Australia, was set up in response to the high male suicide rate in that area, its objective being to support men at risk. Aboriginal men were the most at risk, and they are presently imprisoned at a rate of 13 times more than non-Indigenous men. This small project sought to give voice to the men behind the statistics and point to a significant problem in Australian society.

Interviews were conducted by an Indigenous male, questions covering age at first entering the penal system, number of prison stays, support, and health. This paper is framed around responses to these questions.

All but one of the men were recidivist offenders, and over half were under 15 years of age when first offending. All talked about a lack of support both inside and after leaving prison, and alcohol and depression figured strongly in the accounts. Disadvantage and social exclusion, lack of support such as access to housing and health services, figure significantly in the men’s stories. It is only when social issues are addressed that any gains will be achieved and a cycle of recidivism broken.

To investigate the changes in the provision of preventive health services in terms of woman and child health after reorganization of the primary health care services.

The primary care system in Turkey has undergone fundamental changes as a part of Health Transformation Program during last decade. But there was no community-based study to evaluate these changes.

This community-based and cross-sectional study was conducted in 2010, just before the reorganization of primary care services and in 2015, five year after the reforms. The 30×7 cluster sampling method was used in Zümrütevler quarter of Maltepe District. The socio-demographic characteristics of the participants, the presence of the physician who can be consulted for any health problem, the presence of smokers at home were questioned. The women aged 18 years or older and gave consent provided information about history of pregnancy and birth, the number of follow-ups during pregnancy, family planning method usage, cervical and breast cancer screening, breastfeeding duration, vaccinations, and prophylactic iron and vitamin D supplementation for their children.

After the reorganization of primary care, more people stated that they had physicians to whom they could consult for all kinds of health problems (27.8 versus 44.7%; P<0.001) and that physician was the primary care physician (30.2 versus 64.7%; P<0.001). The reported frequency of at least one smoker at home was decreased after reorganization of primary care (63.6 versus 53.1%; P=0.034). There were no significant differences in terms unplanned pregnancy, the use of family planning method, the number of pregnancy follow-ups and the frequency of Pap smears and mammography. There are no significant differences in terms of healthy children follow-ups, vaccination, vitamin D and iron supplementation (P>0.05). It was found that the duration of total breastfeeding increased after reorganization of primary care (P<0.001).

To explore the introduction of an evidence-based information intervention – the ‘Caring for Someone with Cancer’ booklet – within home care and end-of-life care, to inform future implementation and practice development within this setting.

Family carers’ contribution is crucial to enable care and death of people at home. The ‘Caring for Someone with Cancer’ booklet received positive responses from family carers and District Nurses and is an evidence-based intervention designed to support carers to deliver basic nursing tasks. Further feasibility work was required to establish how it should be implemented. Little is known about how to successfully translate interventions into practice, particularly within home care settings and end-of-life care.

Implementation of the ‘Caring for Someone with Cancer’ booklet, utilising a qualitative case study approach, in four home care sites. Semi-structured interviews, informed by Normalization Process Theory (NPT), were undertaken at implementation sites in May 2016–June 2017. Participants were generalist and specialist nurses, managers, and Healthcare Assistants (HCAs). A framework approach to analysis was adopted.

Forty-five members of staff participated. Failed implementation was associated with organisational-level characteristics and conditions, including workforce composition and predictability of processes. Unstable work environments meant home care providers focused on short-term rather than long-term goals, precluding practice development. Staff’s perceptions of the time available to engage with and implement the intervention inhibited adoption, as many participants were “just getting through the day”. Implementation was successful in sites with explicit management support, including proactive implementation attempts by managers, which legitimatised the change process, and if all staff groups were engaged. To encourage uptake of evidence-based interventions in home care settings, practitioners should be given opportunities to critically reflect upon taken-for-granted practices. Future implementation should focus on work pertaining to the NPT construct ‘Collective Action’, including how staff interact and build confidence in new practices.

Develop and pilot test evidence-based resources for general practice training practices to enhance older patients’ (65+ years) interactions with General Practice Registrars (GPRs).

In Australia, general practice trainees, referred to as GPRs, see fewer older patients and patients with chronic conditions than doctors who have completed their specialist GP training. This reduces learning opportunities for GPRs in the management of these important patient groups. Therefore, developing effective strategies to improve GPR–older patient interaction is critical to primary care training, to meet the current and future needs of an ageing population.

Adopting a social marketing approach, GPR practice resources were developed to address knowledge and attitudinal barriers at the practice and patient level to improve older patient comfort, and willingness to engage, with GPR care. Two focus groups with older patients (n=18) and interviews with staff of training practices (n=12) were utilised to pre-test resources. Amended resources were pilot tested and evaluated in a naturalistic GPR training practice setting using a structured patient questionnaire (n=44).

Pilot evaluation suggests improved comfort and willingness of older patients to interact with GPRs. In all, 54% of survey participants indicated they would be more likely to make an appointment with a Registrar in the future as a result of exposure to the resources. In all, 40% of patients would feel comfortable having a GPR manage a complex or chronic condition, which compares favourably with 28% of similarly aged patients in previous research. The use of tailored, engaging and informative GPR resources for older patients and practice staff may be an important contributor to addressing the growing problem of ensuring GPRs are adequately engaged in treating older patients. The adoption of a social marketing framework was instrumental in enhancing the acceptance and effectiveness of this intervention.

This study aimed to identify and reach consensus among primary health care participants [registered nurses (RNs) who receive clients, directors of nursing, senior physicians, health promotion officers, and local councillors] on the types of service provider that RNs who receive clients represent in the implementation of health promotion practices in primary health care in Eastern Finland.

There is an increasing focus on public health thinking in many countries as the population ages. To meet the growing needs of the health promotion practices of populations, advance practice has been recognized as effective in the primary health care setting. The advance practice nurses share many common features, such as being RNs with additional education, possessing competencies to work independently, treating clients in both acute and primary care settings, and applying a variety of health promotion practices into nursing.

The two-stage modified Delphi method was applied. In round one, semi-structured interviews were conducted among primary health care participants (n=42) in 11 health centres in Eastern Finland. In round two, a questionnaire survey was conducted in the same health centres. The questionnaire was answered by 64% of those surveyed (n=56). For data analysis, content analysis and descriptive statistics were used.

This study resulted in four types of service provider that RNs who receive clients represented in the implementation of health promotion practices in the primary health care setting in Eastern Finland. First, the client-oriented health promoter demonstrated four dimensions, which reached consensus levels ranging between 82.1 and 89.3%. Second, the developer of health promotion practices comprised four dimensions, which reached consensus levels between 71.4 and 85.7%. Third, the member of multi-professional teams of health promotion practices representing three dimensions, with consensus levels between 69.6 and 82.1%. Fourth, the type who showed interest towards health policy reached a consensus level of 55.4% in this study.

Motivational interviewing (MI) is a patient-centered approach that encourages patients to change behaviors. MI training programs have increased residents’ knowledge and use of MI skills; however, many residency programs may not have the time to dedicate to lengthy MI programs. The purpose of this study was to evaluate the benefits of a brief MI didactic for residents in an academic internal medicine patient-centered medical home.

Thirty-two residents completed a 1-h MI training between October 2016 and June 2017 and completed measures on their knowledge of, confidence using, and utilization of MI skills prior to the training, immediately after the training, and at a 1-month follow-up.

The residents’ knowledge of and confidence using MI skills increased from pre-test to post-test and also increased from pre-test to the 1-month follow-up.

The utilization of MI skills increased from pre-test to the 1-month follow-up. A 1-h didactic offers benefits to residents.

International guidelines on diabetes control strongly encourage the setting-up of therapeutic educational programs (TEP). However, more than half of the patients fail to control their diabetes a few months post-TEP because of a lack of regular follow-up by medical professionals. The DIAB-CH is a TEP associated with the follow-up of diabetic patients by the community pharmacist.

To compare the glycated hemoglobin (HbA1c) and body mass index (BMI) in diabetic patients of Control (neither TEP-H nor community pharmacist intervention), TEP-H (TEP in hospital only) and DIAB-CH (TEP-H plus community pharmacist follow-up) groups.

A comparative cohort study design was applied. Patients included in the TEP-H from July 2017 to December 2017 were enrolled in the DIAB-CH group. The TEP-H session was conducted by a multidisciplinary team composed of two diabetologists, two dieticians and seven nurses. The HbA1c level and the BMI (when over 30 kg/m2 at M0) of patients in Control (n = 20), TEP-H (n = 20) and DIAB-CH (n = 20) groups were collected at M0, M0 + 6 and M0 + 12 months. First, HbA1c and BMI were compared between M0, M6 and M12 in the three groups with the Friedman test, followed by the Benjamini-Hochberg post-test. Secondly, the HbA1c and BMI of the three groups were compared at M0, M6 and M12 using the Kruskal-Wallis test.

While no difference in HbA1c was measured between M0, M6 and M12 in the Control group, Hb1Ac was significantly reduced in both TEP-H and DIAB-CH groups between M0 and M6 (P = 0.0072 and P = 0.0034, respectively), and between M0 and M12 only in the DIAB-CH group (P = 0.0027). In addition, a significant decrease in the difference between the measured HbA1c and the target assigned by diabetologists was observed between M0 and M6 in both TEP-H and DIAB-CH groups (P = 0.0072 and P = 0.0044, respectively) but only for the patients of the DIAB-CH group between M0 and M12 (P = 0.0044). No significant difference (P > 0.05) in BMI between the groups was observed.

The long-lasting benefit on glycemic control of multidisciplinary group sessions associated with community pharmacist-led educational interventions on self-care for diabetic patients was demonstrated in the present study. There is thus evidence pointing to the effectiveness of a community/hospital care collaboration of professionals on diabetes control in primary care.