Objective: to map the available evidence on clinical communication of Primary Health Care (PHC) professionals caring for older adults. Method: a scoping review protocol (Open Science Framework ...registry: Descriptors: Health Communication; Aged; Primary Health Care. Objetivo: mapear as evidencias disponiveis sobre a comunicacao clinica realizada por profissionais da Atencao Primaria a Saude (APS) na atencao ao idoso. Metodo: protocolo de revisao de escopo (registro Open Science Framework: Descritores: Comunicacao em Saude; Idoso; Atencao Primaria a Saude.
A key requirement for longitudinal studies using routinely-collected health data is to be able to measure what individuals are present in the datasets used, and over what time period. Individuals can ...enter and leave the covered population of administrative datasets for a variety of reasons, including both life events and characteristics of the datasets themselves. An automated, customizable method of determining individuals' presence was developed for the primary care dataset in Swansea University's SAIL Databank. The primary care dataset covers only a portion of Wales, with 76% of practices participating. The start and end date of the data varies by practice. Additionally, individuals can change practices or leave Wales. To address these issues, a two step process was developed. First, the period for which each practice had data available was calculated by measuring changes in the rate of events recorded over time. Second, the registration records for each individual were simplified. Anomalies such as short gaps and overlaps were resolved by applying a set of rules. The result of these two analyses was a cleaned set of records indicating start and end dates of available primary care data for each individual. Analysis of GP records showed that 91.0% of events occurred within periods calculated as having available data by the algorithm. 98.4% of those events were observed at the same practice of registration as that computed by the algorithm. A standardized method for solving this common problem has enabled faster development of studies using this data set. Using a rigorous, tested, standardized method of verifying presence in the study population will also positively influence the quality of research.
Near-miss events represent an opportunity to identify and correct errors that jeopardize patient safety. This study was undertaken to assess the feasibility of a near-miss reporting system in primary ...care practices and to describe initial reports and practice responses to them.
We implemented a web-based, anonymous near-miss reporting system into 7 diverse practices, collecting and categorizing all reports. At the end of the study period, we interviewed practice leaders to determine how the near-miss reports were used for quality improvement (QI) in each practice.
All 7 practices successfully implemented the system, reporting 632 near-miss events in 9 months and initiating 32 QI projects based on the reports. The most frequent events reported were breakdowns in office processes (47.3%); of these, filing errors were most common, with 38% of these errors judged by external coders to be high risk for an adverse event. Electronic medical records were the primary or secondary cause of the error in 7.8% and 14.4% of reported cases, respectively. The pattern of near-miss events across these diverse practices was similar.
Anonymous near-miss reporting can be successfully implemented in primary care practices. Near-miss events occur frequently in office practice, primarily involve administrative and communication problems, and can pose a serious threat to patient safety; they can, however, be used by practice leaders to implement QI changes.
Abstract
Advances in antiretroviral therapy (ART) have made it possible for persons with human immunodeficiency virus (HIV) to live a near expected life span, without progressing to AIDS or ...transmitting HIV to sexual partners or infants. There is, therefore, increasing emphasis on maintaining health throughout the life span. To receive optimal medical care and achieve desired outcomes, persons with HIV must be consistently engaged in care and able to access uninterrupted treatment, including ART. Comprehensive evidence-based HIV primary care guidance is, therefore, more important than ever. Creating a patient-centered, stigma-free care environment is essential for care engagement. Barriers to care must be decreased at the societal, health system, clinic, and individual levels. As the population ages and noncommunicable diseases arise, providing comprehensive healthcare for persons with HIV becomes increasingly complex, including management of multiple comorbidities and the associated challenges of polypharmacy, while not neglecting HIV-related health concerns. Clinicians must address issues specific to persons of childbearing potential, including care during preconception and pregnancy, and to children, adolescents, and transgender and gender-diverse individuals. This guidance from an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America updates previous 2013 primary care guidelines.
Guidance from an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America updates the 2013 human immunodeficiency virus (HIV) primary care guidelines. The recommendations encompass the comprehensive care of persons with HIV, including comorbidity management.
The Center for Epidemiologic Studies Depression Scale (CES-D) is a commonly used instrument to measure depressive symptomatology. Despite this, the evidence for its psychometric properties remains ...poorly established in Chinese populations. The aim of this study was to validate the use of the CES-D in Chinese primary care patients by examining factor structure, construct validity, reliability, sensitivity and responsiveness.
The psychometric properties were assessed amongst a sample of 3686 Chinese adult primary care patients in Hong Kong. Three competing factor structure models were examined using confirmatory factor analysis. The original CES-D four-structure model had adequate fit, however the data was better fit into a bi-factor model. For the internal construct validity, corrected item-total correlations were 0.4 for most items. The convergent validity was assessed by examining the correlations between the CES-D, the Patient Health Questionnaire 9 (PHQ-9) and the Short Form-12 Health Survey (version 2) Mental Component Summary (SF-12 v2 MCS). The CES-D had a strong correlation with the PHQ-9 (coefficient: 0.78) and SF-12 v2 MCS (coefficient: -0.75). Internal consistency was assessed by McDonald's omega hierarchical (ωH). The ωH value for the general depression factor was 0.855. The ωH values for "somatic", "depressed affect", "positive affect" and "interpersonal problems" were 0.434, 0.038, 0.738 and 0.730, respectively. For the two-week test-retest reliability, the intraclass correlation coefficient was 0.91. The CES-D was sensitive in detecting differences between known groups, with the AUC >0.7. Internal responsiveness of the CES-D to detect positive and negative changes was satisfactory (with p value <0.01 and all effect size statistics >0.2). The CES-D was externally responsive, with the AUC>0.7.
The CES-D appears to be a valid, reliable, sensitive and responsive instrument for screening and monitoring depressive symptoms in adult Chinese primary care patients. In its original four-factor and bi-factor structure, the CES-D is supported for cross-cultural comparisons of depression in multi-center studies.
Studies from different areas, such as social sciences, pedagogy, psychology, and health, show that effective interventions during the first years of life, starting from pregnancy, have lasting ...repercussions until adulthood. From this, public policies and social programs aimed at early childhood emerge, one of them being the municipal project Grow with your Son, which was outlined in 2013 by the City Hall of Fortaleza, Ceará, with the purpose of accompanying the early childhood of families in situation of vulnerability, from pregnancy to three years of age. Contributing with effective care strategies so that families can meet the needs of their children. The program is inserted in the context of primary health care, where the Community Health Agent (CHA) is responsible for weekly home visits. During these visits, the CHA proposes activities to be developed with the children, activities that are in accordance with each stage of development, based on the program manual.
To understand the caregiver's perception of the Grow with your Child program.
This is a field study, exploratory, descriptive, with a qualitative and quantitative approach. It was carried out in two primary health care units in the city of Fortaleza/CE, from May to September 2021. Five families enrolled in the program participated in the survey, who were being monitored weekly in Grow with your Child by the ACS and complying with the schedule. A socioeconomic form was applied to the caregivers, addressing issues of a social and economic nature, such as: Age, Education, Family Income, and the interviews were based on a semi-structured questionnaire developed by the researcher.
The participants were 5 caregivers, mean age 28.6 ± 8.7 years, marital status 60% (n=3) single and 40% (n=2) married, mother's education 20% (n=1) medium incomplete, 60% (n=3) completed high school and 20% (n=1) incomplete college. 40% (n=2) of the mothers do some work at home and 60% (n=3) are dedicated exclusively to the role of mother and home caretaker. The dialogues arising from the semi-structured interviews refer to factors about the caregiver's perspectives on the program. The thematic class - Influence of the Program on Child Development, brought two categories of great importance during the speeches, namely: I. List of exercises and stimuli for development (71.4%) and Influence on affective bonds (28.6%).
The study demonstrated the great importance of this project from the mothers' perception, bringing positive statements about the program's influence on child development, especially in relation to the stimuli through the activities developed, as well as in the strengthening of the families' affective bonds.
Based on the research, it is suggested the inclusion of more professionals in carrying out the program and a better design of the project from the perspective found in this research.
There has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety ...of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed.
This study aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing.
Searches were conducted in MEDLINE, Embase, HMIC, PsycINFO, and CINAHL for literature published since the databases' inception to February 2020. Peer-reviewed studies conducted in primary health care settings were included. All remote consultation types were considered, and studies were required to report any quantitative measure of antibiotic prescribing to be included in this systematic review. Studies were excluded if there were no comparison groups (face-to-face consultations).
In total, 12 studies were identified. Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis, but conflicting results were found for patients with acute respiratory infections. Mixed evidence was found for follow-up visit rates after remote and face-to-face consultations.
There is insufficient evidence to confidently conclude that remote consulting has a significant impact on antibiotic prescribing in primary care. However, studies indicating higher prescribing rates in remote consultations than in face-to-face consultations are a concern. Further, well-conducted studies are needed to inform safe and appropriate implementation of remote consulting to ensure that there is no unintended impact on antimicrobial resistance.
Low-value health care remains prevalent in the US despite decades of work to measure and reduce such care. Efforts have been only modestly effective in part because the measurement of low-value care ...has largely been restricted to the national or regional level, limiting actionability.
To measure and report low-value care use across and within individual health systems and identify system characteristics associated with higher use using Medicare administrative data.
This retrospective cohort study of health system-attributed Medicare beneficiaries was conducted among 556 health systems in the Agency for Healthcare Research and Quality Compendium of US Health Systems and included system-attributed beneficiaries who were older than 65 years, continuously enrolled in Medicare Parts A and B for at least 12 months in 2016 or 2017, and eligible for specific low-value services. Statistical analysis was conducted from January 26 to July 15, 2021.
Use of 41 individual low-value services and a composite measure of the 28 most common services among system-attributed beneficiaries, standardized to distance from the mean value. Measures were based on the Milliman MedInsight Health Waste Calculator and published claims-based definitions.
Across 556 health systems serving a total of 11 637 763 beneficiaries, the mean (SD) use of each of the 41 low-value services ranged from 0% (0.01%) to 28% (4%) of eligible beneficiaries. The most common low-value services were preoperative laboratory testing (mean SD rate, 28% 4% of eligible beneficiaries), prostate-specific antigen testing in men older than 70 years (mean SD rate, 27% 8%), and use of antipsychotic medications in patients with dementia (mean SD rate, 24% 8%). In multivariable analysis, the health system characteristics associated with higher use of low-value care were smaller proportion of primary care physicians (adjusted composite score, 0.15 95% CI, 0.04-0.26 for systems with less than the median percentage of primary care physicians vs -0.16 95% CI, -0.27 to -0.05 for those with more than the median percentage of primary care physicians; P < .001), no major teaching hospital (adjusted composite, 0.10 95% CI, -0.01 to 0.20 without a teaching hospital vs -0.18 95% CI, -0.34 to -0.02 with a teaching hospital; P = .01), larger proportion of non-White patients (adjusted composite, 0.15 95% CI, -0.02 to 0.32 for systems with >20% of non-White beneficiaries vs -0.06 95% CI, -0.16 to 0.03 for systems with ≤20% of non-White beneficiaries; P = .04), headquartered in the South or West (adjusted composite, 0.28 95% CI, 0.14-0.43 for the South and 0.22 95% CI, 0.02-0.42 for the West compared with -0.09 95% CI, -0.26 to 0.08 for the Northeast and -0.44 95% CI, -0.60 to -0.28 for the Midwest; P < .001), and serving areas with more health care spending (adjusted composite, 0.23 95% CI, 0.11-0.35 for areas above the median level of spending vs -0.24 95% CI, -0.36 to -0.12 for areas below the median level of spending; P < .001).
The findings of this large cohort study suggest that system-level measurement and reporting of specific low-value services is feasible, enables cross-system comparisons, and reveals a broad range of low-value care use.
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