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PURPOSE To identify and prioritize the needs for new research evidence for primary health care (PHC) in low- and middle-income countries (LMICs) about organization, models of care, and financing of PHC. METHODS Three-round expert panel consultation of LMIC PHC practitioners and academics sampled from global networks, via web-based surveys. Iterative literature review conducted in parallel. Round 1 (pre--Delphi survey) elicited possible research questions to address knowledge gaps about organization and models of care and about financing. Round 2 invited panelists to rate the importance of each question, and in round 3 panelists provided priority ranking. RESULTS One hundred forty-one practitioners and academics from 50 LMICs from all global regions participated and identified 744 knowledge gaps critical to improving PHC organization and 479 for financing. Four priority areas emerged: effective transition of primary and secondary services, horizontal integration within a multidisciplinary team and intersectoral referral, integration of private and public sectors, and ways to support successfully functioning PHC professionals. Financial evidence priorities were mechanisms to drive investment into PHC, redress inequities, increase service quality, and determine the minimum necessary budget for good PHC. CONCLUSIONS This novel approach toward PHC needs in LMICs, informed by local academics and professionals, created an expansive and prioritized list of critical knowledge gaps in PHC organization and financing. It resulted in research questions, offering valuable guidance to global supporters of primary care evaluation and implementation. Its source and context specificity, informed by LMIC practitioners and academics, should increase the likelihood of local relevance and eventual success in implementing research findings. Key words: primary health care; developing countries; economics; organization and administration; knowledge; research gaps, INTRODUCTION The 1978 Declaration of Alma-Ata called for strengthening of family medicine and primary health care (PHC) globally, particularly in developing countries. (1) As the specialty of family medicine has [...]

Background: Previous research has shown that lifestyle modification can delay or prevent the onset of type 2 diabetes in high‐risk individuals. The Norfolk Diabetes Prevention Study (NDPS) was a parallel, three‐arm, randomized controlled trial with up to 46 months follow‐up that tested a group‐delivered, theory‐based lifestyle intervention to reduce the incidence of type 2 diabetes in high‐risk groups. The current study aimed to evaluate if the NDPS intervention was delivered to an acceptable standard and if any part(s) of the delivery required improvement. Methods: A sub‐sample of 30, 25 for inter‐rater reliability and audio‐recordings of the NDPS intervention education sessions were assessed independently by two reviewers (CT, TW) using a 12‐item checklist. Each item was scored on a 0–5 scale, with a score of 3 being defined as 'adequate delivery'. Inter‐rater reliability was assessed. Analysis of covariance (ANCOVA) was used to assess changes in intervention fidelity as the facilitators gained experience. Results: Inter‐rater agreement was acceptable (86%). A mean score of 3.47 (SD =.38) was achieved across all items of the fidelity checklist and across all intervention facilitators (n = 6). There was an apparent trend for intervention fidelity scores to decrease with experience; however, this trend was non‐significant (p >.05) across all domains in this small sample. Conclusion: The NDPS was delivered to an acceptable standard by all Diabetes Prevention Facilitators. Further research is needed to better understand how the intervention's delivery characteristics can be optimized and how they might vary over time. [ABSTRACT FROM AUTHOR]

Background: Understanding the factors associated with demands for general practice care is crucial for policy decision makers to appropriately allocate healthcare resources. Aim: To investigate factors associated with the frequency of GP consultations. Design & setting: Data on 8086 adults aged ≥16 years was obtained from cross-sectional Health Survey for England (HSE) 2019. Method: The primary outcome was the frequency of consultations of a GP in the last 12 months. Multivariable ordered logistic regression analysis was used to evaluate associations between GP consultations and a range of sociodemographic and health-related factors. Results: Frequency of GP consultations for all reasons was higher among females (odds ratio [OR] 1.81, 95% confidence interval [CI] = 1.64 to 2.01), those aged ≥75 years (OR 1.48, 95% CI = 1.15 to 1.92), ethnic minority populations (Black: OR 1.42, 95% CI = 1.09 to 1.84; Asian: OR 1.53, 95% CI = 1.25 to 1.87), lowest household income (OR 1.53, 95% CI = 1.29 to 1.83), adults with long-lasting illnesses (OR 3.78, 95% CI = 3.38 to 4.22), former smokers (OR 1.17, 95% CI = 1.04 to 1.22), being overweight (OR 1.14, 95% CI = 1.01 to 1.29), and being obese (OR 1.32, 95% CI = 1.16 to 1.50). Predictors of consultations for physical health problems were similar to predictors of consultations for any health problems. However, younger age was associated with more consultations for mental health problems, or a combination of mental and physical health problems. Conclusion: The higher frequency of consultation of GPs is associated with female sex, older age, ethnic minority populations, being socioeconomically disadvantaged, existence of lasting illnesses, smoking, being overweight, and being obese. Older age is associated with increased consultations for physical health problems, but associated with reduced consultations for mental health or a combination of mental and physical health problems. [ABSTRACT FROM AUTHOR]

ABSTRACT. Over five years a former auto salvage yard in Indiana was transformed from an unsightly and hazardous brownfield to an urban green space by student teams from Ball State [...]

Points out the increasing importance of primary care which suggests an important role for the whole primary healthcare team in the education of 'tomorrow's doctors'. Uses a questionnaire survey to elicit the perspective of n=65 community-based nurses involved in a new undergraduate medical course. Reports a need for structural changes in the process of multidisciplinary medical education. Includes 24 references. (Author/YDS)

Introduction The reduction of inequalities in health and health provision is a key aim underpinning both the NHS Plan and the National Service Frameworks. Primary care has a strong role [...]