Educating educators for primary health care

International calls for primary health care (PHC) often referto the need to educate and train appropriate PHC workers ofvarious types. But where are all the trainers for these PHCworkers to come from? Appropriate orientation and educationfor the educators is required. In South Africa, one universityhas started a diploma course especially to educate PHC educators.The rationale for - and unique features of - the course aredescribed.     

Trust in primary care providers and antiretroviral adherence in an urban HIV clinic

Interpersonal trust is an integral component of the patient-provider relationship and has been associated with patient adherence to medications. Studies suggest African Americans may have lower levels of trust in their health care providers than non-Hispanic Whites. This study examines the association between trust in one's primary care provider (PCP) and antiretroviral (ARV) adherence among 175 patients at an urban HIV clinic. Interviews elicited participants' level of trust in their current PCP using a multiple-item trust scale and assessed ARV adherence with a seven-day recall questionnaire. Logistic regression was used to ascertain the effect of trust in PCP on ARV adherence. High trust in PCP was significantly associated with increased odds of ARV adherence compared with low trust (adjusted odds ratio, 2.67; 95% confidence interval, 1.24 to 5.76; p=.01). Enhancing trust in PCPs may be a good target for interventions to improve ARV adherence, particularly among African American patients.     

An eating disorder curriculum for primary care providers.

OBJECTIVE: Primary care providers frequently lack adequate training in treating eating disorders. This study examined the effectiveness of an eating disorder curriculum designed to address the lack of knowledge among primary care providers. METHOD: Medical social workers completed four intensive training sessions, each lasting 75 min. Participants completed questionnaires assessing eating disorder knowledge, perceived ability to treat eating disorders, and practice behaviors, before and after training as well as at 6-month follow-up. RESULTS: The eating disorder curriculum resulted in a significant increase in eating disorder knowledge and a moderate improvement in practice behaviors such as screening new patients for an eating disorder. Training did not significantly change providers' perceived ability to intervene. DISCUSSION: The results of this pilot study suggest that brief intensive training can increase providers' knowledge and change their routine clinical practices, resulting in increased rates of detection and intervention in the primary care setting.     

Preventing occupational illness and injury: nurse practitioners as primary care providers.

Nurse practitioners with master's degrees were surveyed to assess the type and volume of occupational health services provided by primary care as compared with occupational health practitioners and the knowledge base in occupational health in these two groups. Thirty-six percent of 224 nonoccupational health nurse practitioners reported caseloads with 10% or more occupationally related chief complaints; 21% reported treating work-related injury or illness at least once per week. By contrast, a large percentage of nonoccupational health practitioners failed the knowledge-based exam. Large-scale prevention of occupational illness and injury warrants that primary care providers receive training in occupational health.     

A tele-otology course for primary care providers

The shortage of otolaryngologists and the high incidence of ear disease in remote areas are major problems in Australia. We have developed a multimedia course for primary care providers that incorporates material about ear anatomy and physiology, ear disease, video-otoscopy and telemedicine software. The computer-based course was followed by a practical one-day course. A multiple-choice test was given to participants before and at the end of the course and a form was used to record feedback. The course was conducted with 30 aboriginal health workers. The participants were able to obtain images of reasonable to good quality after a short period of training. There was an average improvement of about 25% in the test scores, and the feedback regarding the course was extremely positive. The CD-ROM and the Website provide a valuable resource to assist primary care providers in their care of patients with ear disorders.     

Community-based participatory action research: transforming multidisciplinary practice in primary health care.

OBJECTIVES: Health care systems throughout the world are in the process of restructuring and reforming their health service delivery systems, reorienting themselves to a primary health care (PHC) model that uses multidisciplinary practice (MDP) teams to provide a range of coordinated, integrated services. This study explores the challenges of putting the MDP approach into practice in one community in a city in Canada. METHODS: The data we analyzed were derived from a community-based participatory action research (CBPAR) project, conducted in 2004, that was used to enhance collaborative MDP in a PHC center serving a residential and small-business community of 11,000 within a medium-sized city of approximately 300,000 people in Canada. CBPAR is a planned, systematic approach to issues relevant to the community of interest, requires community involvement, has a problem-solving focus, is directed at societal change, and makes a lasting contribution to the community. We drew from one aspect of this complex, multiyear project aimed at transforming the rhetoric advocating PHC reform into actual sustainable practices. The community studied was diverse with respect to age, socioeconomics, and lifestyle. Its interdisciplinary team serves approximately 3,000 patients annually, 30% of whom are 65 years or older. This PHC center's multidisciplinary, integrated approach to care makes it a member of a very distinct minority within the larger primary care system in Canada. RESULTS: Analysis of practice in PHC revealed entrenched and unconscious ideas of the limitations and boundaries of practice. In the rhetoric of PHC, MDP was lauded by many. In practice, however, collaborative, multidisciplinary team approaches to care were difficult to achieve. CONCLUSIONS: The successful implementation of an MDP approach to PHC requires moving away from physician-driven care. This can only be achieved once there is a change in the underlying structures, values, power relations, and roles defined by the health care system and the community at large, where physicians are traditionally ranked above other care providers. The CBPAR methodology allows community members and the health-related professionals who serve them to take ownership of the research and to critically reflect on iterative cycles of evaluation. This provides an opportunity for practitioners to implement relevant changes based on internally generated analyses.     

Health plan enrollees with disability informing primary care practices and providers about their quality of care: A randomized trial

Background

In October 2013, Massachusetts initiated the One Care demonstration, which enrolls beneficiaries ages 21 to 64 dually-eligible for Medicare and Medicaid. Local disability advocates argued that persons with disability should assess their own One Care quality.

Satisfaction and well-being of primary care providers in managed care

We compared perceptions about the practice environment and the job satisfaction of physician assistants (PAs), nurse practitioners (NPs), and primary care physicians in a large group-model HMO. The data source was a self-administered mail survey (average response rate = 79%). PA/NPs and primary care physicians reported that professional autonomy was not a problem and were satisfied with most aspects of practice in this setting. Common areas of dissatisfaction included patient load and amount of time with patients. PA/NPs were more likely than the physicians to experience stress on a daily basis, however, and were less likely to report that they would choose the practice setting again. They also were significantly less satisfied than the physicians with their incomes and fringe benefits. Our findings suggest that more attention should be given to practice conditions and compensation of PAs and NPs in managed care.     

基层和公共卫生人员激励因素研究

决定卫生服务可及性和质量的主要因素是卫生人员,决定卫生投入效果的主要因素是卫生人员,决定医疗卫生改革成效的主要因素也将是卫生人员。因为他们是卫生服务的直接提供者。卫生人员能否发挥预期作用将取决于两个方面：一是卫生人员的技术能力,包括知识、     

Telehospice acceptance among providers: a multidisciplinary comparison

Telehospice, the delivery of end-of-life care using telecommunications technologies, allows increased interaction between providers and patients. For telehospice to be successful, it must first be accepted by professionals as a useful and user-friendly method of service delivery. Existing research regarding provider acceptance of telehospice has been limited in geographic scope and has often excluded input from key members of the hospice team. This study measured telehospice acceptance in a national sample of hospice professionals from various disciplines (N = 160). Results indicate that acceptance was moderately high overall, although significant differences existed among individuals from different disciplines, with nurses and administrators generally indicating higher levels of acceptance than social workers and chaplains. Findings demonstrate that telehospice interventions will likely be more readily accepted by nursing and administrative staff members, while those employees who address primarily psychosocial issues may be reluctant to use such technology.     

Discontinuity in care: Practice closures among primary care providers and patient health care utilization

We evaluate the consequences for patients of being matched to a new primary care provider due to practice closures. Using an event study and population-level data of patients and providers in Denmark, we find that the transition between providers is smooth; among re-matched patients, there is little change in primary care utilization at the extensive margin. Second, we document a 17% increase in fee-for-service per visit and a large increase in the probability that the patient initiates drug therapy targeting chronic and underdiagnosed diseases (hypertension, hyperlipidemia, and diabetes). Additionally, the re-matched patients are more likely to be admitted to inpatient care for these diseases. The increase in therapeutic initiation is not primarily because the new providers are relatively predisposed to prescribing these drugs. Instead, it appears that when patients match to new providers, there is a consequential reassessment of patients’ medical needs which leads to the initiation of new treatment.     

Health care providers and purchasers and evaluation of interactive health communication applications

Health care providers and purchasers of health services have an opportunity to improve patient care and potentially save costs through the wise purchase of interactive health communication applications for patients and employees. Purchasing decisions based on evaluation and evidence should drive the design and development of new systems. The cycle of evaluation includes a needs assessment before system development, usability testing during development, and studies of use and outcomes in natural settings. This type of evidence is critical to our understanding of how best to provide health information and decision assistance to patients, employees, and others.     

Representations of primary care professionals about the occupational risk of HIV infection

This was a qualitative study, based on the Social Representations Theory, with professionals that work in primary care, about the risk of HIV infection to which they are exposed in their quotidian work routine. Twelve physicians and nurses who work in two Health Centers in the city of Belo Horizonte, MG, Brazil, were interviewed. The final analysis, carried out using the saturation of information criterion, was based on the method proposed by Structural Analysis of Narrative. The results show that the health professionals interviewed knew the infection risk in their work routine, representing it as very low in primary care, because they relate it to technological complexity which they consider does not exist in the level of assistance in which they work. They believed that the use of personal protection equipment may minimize the risks and that, nowadays, no primary care professional refuses to attend a patient due to fear of infection, even if not using all the recommended precautions.