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Background Chest pain is a common symptom in urgent primary care. The distinction between urgent and non-urgent causes can be challenging. A modified version of the HEART score, in which troponin is omitted (‘simplified HEART’) or replaced by the so-called ‘sense of alarm’ (HEART-GP), may aid in risk stratification. Method This study involved a retrospective, observational cohort of consecutive patients evaluated for chest pain at a large-scale, out-of-hours, regional primary care facility in the Netherlands, with 6‑week follow-up for major adverse cardiac events (MACEs). The outcome of interest is diagnostic accuracy, including positive predictive value (PPV) and negative predictive value (NPV). Results We included 664 patients; MACEs occurred in 4.8% (n = 32). For simplified HEART and HEART-GP, we found C‑statistics of 0.86 (95% confidence interval (CI) 0.80–0.91) and 0.90 (95% CI 0.85–0.95), respectively. Optimal diagnostic accuracy was found for a simplified HEART score ≥2 (PPV 9%, NPV 99.7%), HEART-GP score ≥3 (PPV 11%, NPV 99.7%) and HEART-GP score ≥4 (PPV 16%, NPV 99.4%). Physicians referred 157 patients (23.6%) and missed 6 MACEs. A simplified HEART score ≥2 would have picked up 5 cases, at the expense of 332 referrals (50.0%, p p p = 0.18) referrals, respectively. Conclusion HEART-score modifications including the physicians’ ‘sense of alarm’ may be used as a risk stratification tool for chest pain in primary care in the absence of routine access to troponin assays. Further validation is warranted.

Background: The referral system plays a crucial role in antenatal care and childbearing by providing access to emergency obstetric care. Excess referral from primary care and bypassing secondary levels of care leads to overcrowding of high risk and normal mothers in tertiary centers. Hence, this study aims to assess the gaps in the referral of patients with obstetric emergency from primary care to tertiary care. Methodology: In this hospital-based descriptive study, all obstetric patients referred to the Obstetric emergency facility and admitted in postnatal wards during the study period were included. They were interviewed using a pretested questionnaire. Data entry was performed using EpiData version 3.1 and analysis was done using SPSS version 22 software. Results: Of the 505 eligible women who attended the facility, 286 (56%) were referred from other institutions, while 44% were self-referred. Among those referred, one-third were from tertiary level facility and 40% from primary care facility. More than half of the referral was through verbal communication to the patient (60%); only one-third had referral slips. Around 40.4% chose bus and private vehicles (37.6%) as their means of transport; only around 10% traveled in 108 ambulances. Conclusions: Measures to improve the capacity building at primary setting, hierarchy of referral, quality of documentation, and emergency transport mechanism for obstetric patients are vital. The deficits identified in the existing referral system will be useful to give feedback to the health systems of the neighboring regions on emergency obstetrics referrals and to propose referral guidelines.

(1) Background: Patient satisfaction plays an important role in the perceived value, sustained utilization, and coverage of healthcare services by payers and clinics. (2) Methods: A 33-question survey was designed to assess patient satisfaction and perceived value for healthcare services provided by a clinical pharmacist in a single primary care facility. It included general items from validated patient satisfaction surveys (i.e., PROMIS®, CAHPS) and pharmacist-specific items identified in selected literature. It was offered to all patients who were presenting for a new, unique visit with the clinical pharmacist at the medical clinic between May 2019 and April 2020. (3) Results: A total of 66 patients agreed to take the survey (RR = 100%), and the responses were overwhelmingly positive. However, men were more likely than women to report higher satisfaction (X2(1, n = 920) = 0.67, p = 0.027), and new patients reported higher satisfaction than existing patients (X2(1, n = 1211) = 1.698, p = 0.037). (4) Conclusions: The findings of this study indicate a high degree of patient satisfaction with pharmacist-provided healthcare services in the primary care setting.

Background and Objectives: Evaluation of health-related quality of life (HRQoL) among tuberculosis (TB) patients could improve understanding about the burden associated with the diseases. There is a paucity of research regarding evaluation of HRQoL among TB population in Indonesia. This study aimed to investigate HRQoL among TB patients in Ciamis, Indonesia. Methods: This was a cross-sectional study conducted at one primary health-care facility in Ciamis, Indonesia. HRQoL was measured using the World Health Organization (WHO) QoL-BREF instrument which covers assessment on physical, psychological, social relationship, and environmental health domains. Multiple regression analysis was used to investigate the association between domain scores with demographic factors of the participants such as age, sex, education years, and types of treatment. Statistical analysis was conducted using SPSS software version 21. Results: Eighty-one participants were recruited in the present study. The total mean score for all domains was 45.35 (±23.3). The mean scores for physical, physiological, social relationship, and environmental health domains were 20.5 (±9.9), 76.4 (±11.9), 36.9 (±9.2), and 46.9 (±10.4), respectively. Education years were significantly associated with improved HRQoL in environmental health domain (P < 0.05). Conclusion: TB had remarkable negative impacts on patients HRQoL, with physical domain was the most affected. This finding calls upon strategies addressing HRQoL problems in the management of TB patients.

Perinatal and neonatal deaths account for an increasing proportion of deaths under 5 years old. We present essential elements to reduce perinatal mortality, barriers to establishing these elements, and the role of developing emergency care systems. Essential elements for prompt perinatal and postnatal care are categorised based on care-seeking behaviours, access to a primary care facility and for the severely ill, access to advanced neonatal care. The role of emergency care systems is key to overcoming obstacles currently faced in countries with high perinatal and neonatal mortality rates.

Background: Recent studies show that ART is associated with an adverse birth outcome in HIV-infected women.Aim: To compare rates of low birthweight (LBW) and preterm birth (PTB) between HIV-infecte...

Purpose:An individual’s lack of social connections and social isolation is often associated with feelings of loneliness which is regarded as having a negative effect on health. This paper describes the development and assessment of a 10 item ‘Personal Sociability and Connections Scale’ (PeSCS) to measure individual’s disposition and accompanying skills to seek out companionship and engage in interpersonal relations.Methods:The study was conducted at a rural primary care unit in Northern Greece. A total of 199 attenders were recruited over a 6-week period in 2020 and questionnaires completed. This informed the 10-items PeSCS that comprises Social, Behavioral, and Emotional components focusing on the expression of social comfort, willingness to share experiences, stories and concepts, and feelings of similarity at first contact. Reliability of the PeSC scale was assessed and the relationship with scale scores examined as an indicator of convergent validity. A multivariate linear regression analysis was performed to examine the relationship of PeSC scale score with the characteristics of participants.Results:Assessment of reliability of PeSC scale produced a Cronbach’s alpha of 0.809. The relationship between components and the total PeSCS scores identified significant correlations ( p Conclusion:The 10-item PeSC scale forms a simple and quick to complete measure whose overall reliability was rated as ‘meritorious’. The PeSC instrument may be a useful tool for assessing the causes and appropriate responses to the negative health effects of loneliness and social isolation.

This study constructed a scale for measuring nurses' physical activity (PA) counseling in healthcare from the points of view of regular patients. Confirmatory factor analysis produced a two-factor solution with 7 items. The first factor extracted was "follow-up", which accounted for a variance of 44.5% out of a total variance of 64.8% and comprises 4 items. The second factor, "PA recommendation", accounted for a variance of 20.3% and comprises 3 items. The final scale had a good internal consistency (Cronbach's

Objective: To characterize the access to primary dental care and the work process of Oral Health Teams (OHTs), nationwide and by geographic region, based on data from the 3rd phase of the PMAQ-AB (the Program for Improving Access and Quality of Primary Care) . Material and Methods: This was a cross-sectional study using data from the external assessments of the PMAQ-AB regarding the variables access to dental care and the work process of OHTs. The data were analyzed descriptively. Results: A significant number of healthcare users (41.2%) reported an average waiting time of 10 days to schedule dental appointments at the primary care facility (PCF). In the Northeast region, a greater number of users (48.4%) had access to dental care, with a waiting time of 7 days, whereas a smaller number of users in the Southeast region could schedule an appointment with the dentist (33.9%) and experienced a longer waiting time (17 days). Most OHTs worked in Primary Care Teams (PCTs) (85.1%), received support from Specialized Dental Care Centers (70.9%), worked with scheduled appointments and/or spontaneous demands (98.0%), listened to the users’ complaints during user embracement sessions (99.0%), and scheduled the first appointment at the dental office (51.9%) . Conclusion: In Brazil, 41.2% of the healthcare users had access to dental care and experienced a waiting time ranging from 7 to 17 days, depending on the geographic region. While the OHTs developed primary oral care actions, further initiatives to ensure the expansion of access to dental care are needed.

IntroductionHIV incidence is high during pregnancy and postpartum in many settings. PrEP is safe and effective but requires adherence during potential HIV exposure, yet the facilitators of high maternal adherence are not well understood in high HIV burden settings.MethodsWe conducted semi-structured interviews with women who reported high adherence (PrEP use ≥ 25 days in last 30-days) within a PrEP service for pregnant and postpartum women located in a large primary care facility in a high-HIV burden township. Topics for interviews included: individual/interpersonal risk, disclosure, anticipated PrEP stigma, safety, side-effects, and facility-level factors effecting adherence. A thematic approach guided an iterative process of coding (reviewed to ensure intercoder reliability) and analysis using NVivo 12.ResultsWe interviewed 25 postpartum women with high PrEP adherence who were on PrEP for a median of 9-months, median age 26-years, and median baseline gestational age 24-weeks. Themes identified as key drivers of optimal PrEP use were HIV risk perception – primarily due to partner’s perceived risky sexual behaviors and unknown serosatus—and a strong desire to have a baby free of HIV. Reported disclosure of PrEP use to family, partners and friends facilitated PrEP adherence. Women continued PrEP postpartum because they felt empowered by PrEP and did not want to “go backwards” and increase their HIV risk as before PrEP. Women who reported high adherence all discussed having community support and reminders to take PrEP on time. The primary barriers were anticipated or experienced stigma, which most overcame through education of partners/family about PrEP. Pregnant women experienced transient side effects, but found ways to continue, including taking PrEP at night. Women believed PrEP education and counselling were accessible when integrated into antenatal care which contributed to continued PrEP use.ConclusionsFacilitators of optimal PrEP use through pregnancy and postpartum included fear of HIV acquisition for self and infant, mostly due to partner sexual behaviors and unknown serostatus, along with PrEP disclosure, and encouragement from partners and family. PrEP programs for pregnant and postpartum women should integrate strategies to assist women with realistic appraisals of risk and teach skills for securing support for significant others.

Aim. To conduct a pharmacoepidemiologic analysis of lipid-lowering therapy (LLT) in outpatients of different ages with coronary artery disease (CAD).Material and methods. A total of 805 medical records of outpatients with CAD were analyzed in this pharmacoepidemiologic, cross-sectional study conducted at primary care facility of Moscow. The total sample of patients was divided into 3 age groups: group 1 — Results. LLT prescription rates were equally high in all ages — 92,9%, 85,9%, and 81,6% in groups 1, 2, and 3 respectively (p>0,05). Dual LLT was prescribed rarely (4,9%, 3,9%, 0,9%, respectively), especially in patients ≥75 years (p0,05); patients ≥75 received rosuvastatin less often (p0,05), as well as the proportion of patients not achieved target LDL-C 0,05).Conclusion. The study demonstrated no significant influence of patient age on LLT prescription rates, LDL-C control, and prevalence of irrational drug combinations in outpatients with CAD. Rates of dual LLT, structure and intensity of statin therapies differed depending on age groups.

Background Maternal and Child Health is a global priority. Access and utilization of facility-based health services remain a challenge in low and middle-income countries. Evidence on barriers to providing and accessing services omits information on the role of security within facilities. This paper explores the role of security in the provision and use of maternal health services in primary healthcare facilities in Nigeria. Methods Study was carried out in Anambra state, Nigeria. Qualitative data were initially collected from 35 in-depth interviews and 24 focus groups with purposively identified key informants. Information gathered was used to build a programme theory that was tested with another round of interviews (17) and focus group (4) discussions. Data analysis and reporting were based on the Context-Mechanism-Outcome heuristic of Realist Evaluation methodology. Results The presence of a male security guard in the facility was the most important security factor that facilitated provision and uptake of services. Others include perimeter fencing, lighting and staff accommodation. Lack of these components constrained provision and use of services, by impacting on behaviour of staff and patients. Security concerns of facility staff who did not feel safe to let in people into unguarded facilities, mirrored those of pregnant women who did not utilize health facilities because of fear of not being let in and attended to by facility staff. Conclusion Health facility security should be key consideration in programme planning, to avert staff and women’s fear of crime which currently constrains provision and use of maternal healthcare at health facilities.

Aims: This study aims to describe the prescribing patterns of antihypertensive medications and short term outcomes of these patients, defined as repeat blood pressure measurements by a medical professional within 6 months, in a primary care facility in Puchong, located within the state of Selangor in Malaysia. Methods: This study was a cross-sectional, retrospective analysis of patients with essential hypertension, aged 18 and above, with blood pressure recorded at least twice within a 6-month period in an urban primary care clinic in Malaysia. Patients with history of co-morbidities were excluded. The prescribing patterns of antihypertensive medications and proportion of patients who achieved blood pressure control of less than 140/90 mmHg were ascertained. Results: A total of 200 prescriptions were analysed, including 52.5% females taking a mean of 1.7 (0.7) antihypertensive medications with a mean age of 57.9 (12.4) years. Most of the patients were prescribed either a single medication (n=90, 45.0%) or two medications (n=90; 45.0%) to control their blood pressure. Only 20 patients (10.0%) were prescribed three antihypertensive medications. A total of 127 (63.5%) patients met the blood pressure target of less than 140/90 mmHg. All participants exhibited a significant drop in systolic blood pressure, reducing from 143.0 (16.0) mmHg at baseline to 135.3 (14.8) mmHg at the end of 6 months (p

We develop a stochastic model for a carve-out appointment system for a single physician in a primary care facility that allocates certain slots for same-day requests while reserving the rest for appointments requested in advance. Several slots are double-booked to mitigate the negative impacts from no-shows. Our model takes into account the stochastic demands of both routine patients and same-day requests as well as no-shows and optimizes the overall system performance, which includes the primary care provider’s utility and patients’ waiting time. We derive the optimal number of open slots, the maximum number of patients allowed to be double-booked, and where these open slots and double-booked slots should be placed. A key contribution of our approach is that both capacity decisions and scheduling decisions are obtained simultaneously. Moreover, our approach allows the optimal schedules to be analytically characterized by the demand distribution of same-day requests, the no-show rate, and the ratio of overtime cost to waiting cost for the special case where it is optimal to leave one open slot and one double-booked slot. Numerical results are used for more general cases to provide managerial insights on the usage of open slots and double-booked slots. The optimal schedule should start with a few open slots. If the no-show rate is low, single-booked slots should be placed before the first double-booked slots. On the other hand, if the no-show rate is high, a double-booked slot should be placed immediately after the series of open slots. Additional open slots should be inserted either between two double-booked slots or between one double-booked slot and a series of single-booked slots. The strategic placement of open slots not only increases the physician’s utilization but also improves patients’ aggregated waiting time.

Research Objectives To determine the feasibility of a clinic-to-clinic tele-rehabilitation model in rural Alberta. Design This pilot study employed a Plan-Do-Study-Act (PDSA) methodology. We focused on 4 clinical areas: Hip & Knee post-arthroplasty follow-up, Vestibular & Balance issues, Severe Shoulder Pain & Instability, and Wheelchair Seating. We co-developed assessment processes with non-physician experts that connected to a general physiotherapist using new technologies. After a series of in-house trials, these assessments were then deployed to 5 rural communities in Alberta. Technologies included Kinetisense Markerless Motion Capture and a telepresence robot. Patients were provided with a minimum of two clinical visits, with follow-up approximately 4 weeks after initial assessment. Experience and outcome measures centered on ICF principles were collected from both patients and clinicians. Setting The study took place in public and private rehabilitation settings and a primary care facility. Participants Participants were selected from a convenience sample by local practitioners. Initial and follow-up assessments for 16 patients in this pilot study were completed. Interventions A novel suite of technologies and processes were developed through close consultation with expert clinicians to enable complex rehabilitation assessments to be conducted remotely. Main Outcome Measures A mix of outcome and experience measures determined the effectiveness of this model. The COPM, and a study-specific Patient Reported Experience Measure, measured patient outcomes. Two study-specific Clinician Reported Experience Measures provided clinician data. Results Across our 4 modules, 14 out of 16 participants either agreed (3) or strongly agreed (11) that they enjoyed their Tele-Rehab session overall. No participants disagreed, and 2 were neutral. Based on COPM scores, overall patients saw improvements in both performance and satisfaction for their identified goals.The remote clinicians were all confident in the treatment plans prescribed by the hub clinician (n=13, 4 Agree, 9 Strongly Agree). Both hub and remote clinicians had confidence in each other, and all agreed (5) or strongly agreed (18) that the assessments were a success. Conclusions Preliminary results indicate that this is an effective way of delivering care, but additional study is required. Author(s) Disclosures N/A.

This is a case of a man referred from a primary care facility to an emergency department because he had strong pains of the spine that had already been present for 2 weeks. He was hospitalized in an endocrinology clinic due to his uncontrolled diabetes. During this stay, he had several Raynaud’s syndrome attacks. Very soon after an attack he felt a strong and characteristic pain in his chest. The angiography of coronary vessels was performed when the patient was experiencing pain showed a spasm in the initial part of the left anterior descending artery which later stopped after an intracoronary nitroglycerin dose was administered. Markers of myocardial necrosis were not increased. This clinical picture and results of additional tests point towards Prinzmetal angina (coronary vessel spasm). The interesting thing is that the pain in the chest was always preceded by a paroxysmal arterial spasm in the fi ngers which also turned pale and the patient experienced a “pins and needles” sensation. Then the skin would turn blue and then red and later burn. The drug therapy which, following our decision, was the same in both cases, eliminated the ailments of the chest and fingers.

Accessibility is a key element of an effective primary care system. Literature has outlined that primary care practices have successfully employed an advanced access scheduler to improve accessibility to booked appointments and consequently enhance patient experience and outcomes. In 2015, a Canadian Armed Forces (CAF) primary care facility in Ottawa trialed an advanced access scheduler. Based on the unique characteristics of a CAF medical clinic and the patient population, this trial produced six critical lessons, which include maintenance of a stable base of clinicians, correcting rostering mismatches, eliminating appointment backlogs, acquiring required information systems, improved understanding of patient demand and communicating changes effectively. These lessons may be utilized by similar organizations to successfully integrate an advanced access scheduler within their primary care facilities.

Information on major depressive disorder (MDD) in primary care settings in sub-Saharan Africa is limited, yet this is required to improve service development. We explored prevalence and factors associated with MDD among adolescents attending a primary care facility in urban Uganda. At Naguru Teenage Information and Health Centre, 281 adolescents were assessed for MDD using the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-Kid). Prevalence and risk factors were determined using frequencies and regressions, respectively. The prevalence of adolescent MDD was 18.2 %. Vulnerability factors were orphanhood, childhood trauma (particularly emotional abuse and physical neglect) while social support was protective. Considerable burden of clinically significant depression exists in primary care settings in Uganda; this may well contribute to a poor quality of life.

Background The antiretroviral therapy (ART) adherence club (AC) differentiated service delivery model, where clinically stable ART patients receive their ART refills and psychosocial support in groups has supported clinically stable patients’ retention and viral suppression. Patients and health systems could benefit further by reducing visit frequency and increasing ART refills. We designed a cluster-randomized control trial comparing standard of care (SoC) ACs and six-month ART refill (Intervention) ACs in a large primary care facility in Khayelitsha, South Africa. Methods Existing ACs were randomized to either the control (SOC ACs) or intervention (Intervention ACs) arm. SoC ACs meet five times annually, receiving two-month ART refills with a four-month ART refill over year-end. Blood is drawn at the AC visit ahead of the clinical assessment visit. Intervention ACs meet twice annually receiving six-month ART refills, with a third individual visit for routine blood collection anytime two-four weeks before the annual clinical assessment AC visit. Primary outcomes will be retention in care, annual viral load assessment completion and viral load suppression. (

Supravalvar mitral ring is a rare congenital abnormality characterized by a ridge of connective tissue located above the mitral valve. It is a cause of congenital mitral stenosis typically presenting in childhood and usually associated with other cardiac abnormalities. We report the rare case of a 24-year-old male presenting with an isolated aneurysmal supravalvar mitral ring. He presented at the emergency room with a 2-week history of worsening heart failure symptoms and antecedent effort intolerance of 4 years duration. He was referred from a primary care facility with an echo diagnosis of cor-triatriatum. Echocardiography done at our centre revealed an isolated aneurysmal supravalvar mitral ring of the intramitral variant. This report highlights the unusual isolated presentation of a supravalvar mitral ring in a young adult and the need to carefully differentiate it from cor-triatriatum, a possible close mimic.

Objetivo: determinar la prevalencia de depresión en adultos mayores en una Unidad de Medicina Familiar (umf) de Michoacán, México y su asociación con el género, la escolaridad y la edad. Métodos: estudio transversal analítico. Participaron adultos mayores de 60 a 84 años de edad en la umf No. 5 de Sahuayo, Michoacán, de marzo a junio de 2019, se utilizó el test de Yesavage. El género, el grado de escolaridad y la edad fueron consideradas como factores asociados. Se utilizó la prueba de χ2 para identificar las diferencias de proporciones entre los factores asociados y r de Spearman para determinar correlación. Resultados: se incluyó a 117 adultos mayores. La prevalencia de depresión en la muestra fue de 40.17 %. No se observaron diferencias en la proporción por género (femenino: 53.85 % y masculino: 46.15, p= 0.79%), en el grado de escolaridad (primaria: 82.91 %, secundaria: 11.97 %, preparatoria: 3.42 % y licenciatura: 1.71 %, p= 0.57), o en la edad (p>0.05). El análisis de correlación no mostró asociación entre ninguna de las variables. Conclusiones: la prevalencia de depresión en adultos mayores fue mayor a la reportada en otros grupos; no obstante, en la muestra estudiada no se observaron las asociaciones con el género, la escolaridad y la edad, aspectos que se han reportado previamente. La depresión en los adultos mayores es una patología que se encuentra subdiagnosticada y no manifiesta un rasgo determinante, por lo que el médico de primer nivel deberá realizar una búsqueda intencionada.

Background : Diabetes mellitus (DM) is one of the top ten chronic diseases in the world and the prevalence of this disease will increase in the future including in Indonesia. Treatment of DM needs collaboration between the patients and the providers to prevent multiorgan complications and increase the compliance to treatment. The correlation among the level of knowledge (K), attitude (A) and practice (P) plays an important role of patients towards compliance to treatment. The objectives of this study was to identify the level of knowledge, attitude and practice of DMT2 patient towards compliance to treatment at a primary care facility. Methods : This study was carried out by using cross sectional descriptive study from August until November 2013 in Public Health Center (Pusat Kesehatan Masyarakat/Puskesmas) Tanjungsari, Sumedang, West Java. There were 49 respondents and the sampling method used was non-probability sampling. The data was collected through face to face interview using questionnaire which consist of 27 questions about knowledge, attitude and practice. The collected data was anayzed using computer and was presented in the form of tables and a figure. Results : This study discovered that 22 patients had moderate knowledge, 17 patients had good knowledge and 10 patients had poor knowledge. As for attitude, there were 32 patients had good attitude and 17 patients had moderate attitude. Whereas, for practice, 44 patients were good and 5 patients were moderate. Conclusions : Majority of respondent had moderate knowledge, good attitude and practices. [AMJ.2016;3(3):416–20] DOI: 10.15850/amj.v3n3.871

Purpose – The purpose of this paper is to evaluate the performance on standardizing appointment slot length in a primary care clinic to understand the impact of providers’ preferences and practice differences. Design/methodology/approach – The treatment time data were collected for each provider. There were six patient types: emergency/urgent care (ER/UC), follow-up patient (FU), new patient, office visit (OV), physical exam, and well-child care. Simulation model was developed to capture patient flow and measure patient wait time, provider idle time, cost, overtime, finish time, and the number of patients scheduled. Four scheduling scenarios were compared: scheduled all patients at 20 minutes; scheduled ER/UC, FU, OV at 20 minutes and others at 40 minutes; scheduled patient types on individual provider preference; and scheduled patient types on combined provider preference. Findings – Standardized scheduling among providers increase cost by 57 per cent, patient wait time by 83 per cent, provider idle time by five minutes per patient, overtime by 22 minutes, finish time by 30 minutes, and decrease patient access to care by approximately 11 per cent. An individualized scheduling approach could save as much as 14 per cent on cost and schedule 1.5 more patients. The combined preference method could save about 8 per cent while the number of patients scheduled remained the same. Research limitations/implications – The challenge is to actually disseminate the findings to medical providers and adjust scheduling systems accordingly. Originality/value – This paper concluded standardization of providers’ clinic preference and practice negatively impact clinic service quality and access to care.

3 Commando Brigade’s delivery of pre-hospital (Role 1) care has until now largely been based around junior doctors delivering trauma-based resuscitation and limited primary care from small self-contained Regimental Aid Posts (RAPs). With the drawdown of large scale operations in Iraq and Afghanistan, and the diversity of potential future military operations, the deficiency of General Practitioner(GP)-led care in the deployed setting has become more evident, and this has driven the requirement for a deployable primary care facility in the form of a Medical Reception Station (MRS). This paper describes the evolution of this project, the realities of deploying a new medical capability for the first time, some of the issues faced, and the potential utility of such a medical facility in future.

Compare risk factors of hospital readmission between 30-, 60- and 90-day readmission groups in a low socioeconomic population.Secondary data obtained from the Epic Systems database management system for patients who experienced a 30-, 60- or 90-day hospital readmission between 2006 and 2013. Risk factors analyzed included sex, race/ethnicity, follow-up status, age, BMI, systolic blood pressure, body temperature and pulse rate. Records for 2191 low-income patients (µ age = 44.5 years; 72.5% female; 10.1% African American, 26.2% Hispanic, 63.7% White) from a central Texas acute health and primary care facility.The amount of time that passed between a patent's initial hospital encounter and a follow-up visit had an effect in predicting both 60-day (OR = 1.055) and 90-day (OR = 1.088) hospital readmission. Patient race/ethnicity had an effect in predicting 90-day readmission. Hispanic patients had a lower likelihood of being readmitted after 90 days than being readmitted after 30 days as compared with White, non-Hispanic patients (OR = 0.688).Our study suggests that risk factors identified at 30 days are similar to those at 60 and 90 days, with the exception of follow-up status and race/ethnicity.

Quantitative methodology investigating medical resource accessibility does not incorporate patients’ feelings about the adequacy and fairness of primary health care (PHC). In this study we quantified the spatial accessibility of PHC from the patient perspective. The main obstacles regarding access to PHC services are: (1) distance from the medical facility; and (2) waiting times after reaching the facility. The total time cost to access PHC is calculated as the sum of the time cost to access the PHC facility and the time cost waiting to receive health care; the total time cost was used in this study to reflect the potential spatial accessibility (i.e. probable entry into the healthcare system) of PHC. In Shanghai, it took residents approximately 13min to reach the nearest primary care facility, with an approximate 23min wait time after arriving at the facility. Thus, the spatial accessibility of PHC in Shanghai is approximately 36min. The method of assessing the spatial accessibility of PHC from the perspective of patients is more explanatory and easier to interpret. In the case of Shanghai, the regional accessibility of PHC is much better than its regional availability. Relevant managers should focus on increasing the resource supply capacity of existing facilities providing primary care in the suburbs of Shanghai.

Acute respiratory infections (ARIs) are the leading cause of morbidity and mortality in children under five years, with a periodic prevalence of 25.9% in West Papua (2013). This study aims to explain the factors associated with ARIs in under-5 children in Sorong District, West Papua. This cross-sectional study was conducted in two districts, where trained medical students interviewed 135 mothers/caregivers by using a structured questionnaire and interviewed cadres and health workers for qualitative observation. About 85.5% of respondents stated that their children had ARIs in the previous two weeks (n=135), much higher than the data from Sorong District Health Office, which only reached 24.63%. Dominant risk factors were large household size, smoking at home, and improper handwashing habits. Only half of the respondents went to a physician in a primary care facility. Nearly half of the respondents had difficulty in accessing the facility. The majority of caregivers used over-the-counter or traditional medicine. Around 70% of respondents in Makbon Subdistrict did nothing to prevent the transmission of ARIs among children. ARIs remains a massive problem in the Sorong district. We need to educate the mothers/caregivers about the rational use of medicine and the prevention of ARIs, and also advocate for better access to clean water, sanitation, and healthcare facilities.

Adapting primary health care to the needs of migrant patients requires adaptation at individual, organizational and structural levels. This chapter will review the available evidence regarding adaptations of primary health for migrants and identify examples of best practices that may serve as template for those willing to implement such interventions in their primary care facility.

Background: Research consistently demonstrates the importance of effective team work for improving the quality of health care. We conducted a baseline measure of primary health care (PHC) team effectiveness and overall PHC performance at a primary care facility. Aim: To improve PHC team effectiveness and ultimately the quality and user experience of primary care at a community health centre (CHC). Setting: Du Noon CHC in the southern and western substructure of the Cape Town Metro district services (MDHS). Methods: A cross-sectional study using a combination of the Nominal Group Technique (NGT) consensus method and the South African Primary Care Assessment Tool (ZA PCAT) to assess PHC team effectiveness and PHC organisation and performance. Results: The ZA PCAT was administered to 110 CHC users (patients) and 12 providers (doctors and clinical nurse practitioners). Data from 20 PHC team members showed they perceived their team as well functioning (70% agreement on a 7-item PHC team assessment tool incorporated into the ZA PCAT). The NGT method achieved participant (20) consensus on communication and leadership as the main challenges to effective team functioning and on ideas to overcome the challenges. The ZA PCAT user data showed 18.2% of users rated first contact access as acceptable to good; 47.3% of users rated ongoing care as acceptable to good. Provider data showed that 33% of providers rated first contact access as acceptable to good; 25% of providers rated ongoing care as acceptable to good. First contact access received the lowest acceptable to good score (18.2%) and comprehensiveness (services available) the highest score (88.2%) from users. For the providers, the lowest acceptable to good score was for ongoing care (25%) and the highest acceptable to good score was for primary health care team availability (100%). The ZA PCAT total primary scores were good (above 60%) for both users and providers but moderately higher for the providers. Conclusion: Knowledge of how teams perceive their effectiveness can motivate them to generate ideas for improving performance. There were discrepancies between providers’ assessment of team functioning using the ZA PCAT measure and the NGT method results. The ZA PCAT also showed differences between providers’ and users’ perceptions of PHC performance – consistent with the findings of the multi-CHC Western Cape ZA PCAT study. These findings should encourage and support CHC and district level staff in their efforts to improve the quality and user experience of primary care, as well as PHC team performance.

Malaysia's approach to reducing the burden of HPV-related disease has centred on adolescent vaccination and cervical screening with Pap smears. While the vaccination programme has been broadly successful, Pap smear screening has been less successful. In an effort to improve screening uptake, the ROSE 1.0 pilot aimed to create more efficient screening, with improved quality and lower total cost.

The aim of this case-control study was to evaluate the overall behavior of children with vocal fold nodules (VNs).The study group included children with VNs between 4 and 15 years old diagnosed using fiberoptic video laryngoscopy with stroboscopy in a tertiary university hospital. As a control group, children between 4 and 13 years old without VNs, routinely followed up in a primary care facility, were included in the study. Parents of the participants completed the parent-proxy strengths and difficulties questionnaire (SDQ), a brief behavioral screening questionnaire designed for children. The SDQ evaluates emotional, conduct, and peer problems, and also focuses on hyperactivity and prosocial behavior. Children are classified into "normal," "borderline," or "abnormal" according to the total SDQ score.Twenty-seven children (24 boys and 3 girls) with VNs and 41 controls (33 boys and 8 girls) were enrolled in the study. The two groups did not differ significantly in age or gender (P 0.05). Statistical analysis revealed that 52% individuals of the VNs group presents borderline or abnormal overall behavioral, which is statistically different from the general population (P 0.001). Total, hyperactivity, and prosocial SDQ subscales were statistically different between study groups (P 0.05).Our findings suggest association between VNs and hyperactivity and also with poorer prosocial behaviors in children for the first time. We propose that every child with VNs must be evaluated from a behavioral point of view to detect and to treat potential underlying psychological conditions that may interfere with VNs treatment and prognosis.

Digital healthcare is becoming increasingly important as the ageing population and the number of people diagnosed with chronic diseases is increasing. The face of healthcare delivery has changed radically and at its core is a digital and customer revolution. Connected health is the convergence of medical devices, security devices, and communication technologies. It enables patients to be monitored and treated remotely from their home or primary care facility rather than attend outpatient clinics or be admitted to hospital. This chapter discusses the recent advances in connected health technologies and applications. The authors investigate a reconfigurable supporting connected health solution for people with chronic diseases using reconfigurable hardware and intelligent data interpretation and analysis. In addition, a thorough review of the existing information and communications technologies and challenges in the area of connected health including embedded medical devices, sensors, social networking, knowledge management, data fusion, and cloud computing is presented in this chapter. Finally, future directions and ongoing research in the area of connected health are presented. - 2018 by IGI Global. All rights reserved. Scopus

The Dream Center Neurology Clinic (DCNC) is a free specialty clinic associated with the Medical University of South Carolina that provides health care for uninsured patients with neurologic disorders. Routine neurologic care is often neglected by free primary care clinics, leaving indigent and uninsured patients to suffer from treatable neurologic ailments. The DCNC was established by supplementing existing resources from a free primary care facility called the Dream Center. Our strategy of building a high-need specialty service into a preexisting primary care infrastructure may provide a blueprint for neurologists who are eager to address the neurologic needs of the underserved in their local communities. According to local charge estimates, the DCNC has provided roughly $120,000 worth of outpatient neurologic care over the past year. The clinic runs through the collaborative effort of medical students as well as academic and private health care providers. Donated services such as EEG, diagnostic lab work, botulinum toxin, supplies, and imaging are also critical to clinic operations. In addition to providing the uninsured with services that are normally inaccessible to them, the DCNC provides a unique educational opportunity for medical students, residents, and all volunteers who are eager to help and learn.