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Problem To prioritize key areas of action and investment for the next strategic cycle of national development plans (2026-2031) in Oman, we needed a holistic view of the country's health system and its main deficiencies and inefficiencies. Approach Informed by the World Health Organization framework, our team of seven national health ministry staff and two international experts conducted a rapid health system performance assessment. We used already available data to identify system bottlenecks and their potential root causes, verifying our findings with key informant interviews. Local setting Oman's 4.9 million population is relatively young (average age 28 years) but ageing, with a mounting burden of chronic diseases. While health-care services are free for Omani nationals, more than 1.5 million expatriates rely on out-of- pocket payments for health-care services. Strengthening primary health care, improving the quality of care, providing financial protection, and ensuring that public and private health-care providers operate within the same legal and procedural framework are recognized as key national priorities. Relevant changes Our assessment highlighted the need to extend health service coverage to the whole population, strengthen private health-care sector governance, improve health education, increase financial investment, and expand the country's capacity for data collection and analysis. Lessons learnt The assessment framework allowed us to identify areas where information is lacking and use already available data to analyse multiple health outcomes. As well as identifying issues that need to be addressed during the next policy development cycle, our findings have contributed towards the preparation of a more extensive assessment. [phrase omitted] [phrase omitted] Probleme Afin de hierarchiser les domaines d'action et d'investissement cles pour le prochain cycle strategique des plans de developpement nationaux (2026-2031) a Oman, une vision globale du systeme de sante du pays et de ses principales faiblesses et inefficacites etait necessaire. Approche S'inspirant du cadre de {'Organisation mondiale de la sante, notre equipe, composee de sept membres du personnel du ministere de la Sante et de deux experts internationaux, a procede a une evaluation rapide de la performance du systeme de sante. Nous avons utilise les donnees deja disponibles pour Identifier les goulets d'etranglement du systeme et leurs eventuelles causes premieres, et nous avons verifie nos conclusions a l'aide d'entretiens avec des informateurs cles. Environnement local La population d'Oman, qui compte 4,9 millions d'habitants, est relativement jeune (l'age moyen est de 28 ans), mais vieillissante, et le fardeau des maladies chroniques s'alourdit. Alors que les services de sante publique sont gratuits pour les Omanais, plus de 1,5 million d'expatries paient directement leurs soins de sante. Le renforcement des soins de sante primaires, l'amelioration de la qualite des soins, l'offre d'une protection financiere et la garantie que les prestataires de soins de sante publics et prives operent dans le meme cadre juridique et procedural sont reconnus comme des priorites nationales essentielles. Changements significatifs Notre evaluation a mis en evidence la necessite d'etendre la couverture des services de sante a l'ensemble de la population, de renforcer la gouvernance du secteur des soins de sante prives, d'ameliorer l'education a la sante, d'accroitre les investissements financiers et de developper les capacites du pays en matiere de collecte et d'analyse des donnees. Lecons tirees Le cadre devaluation nous a permis d'identifier les domaines ou des informations font defaut et d'utiliser les donnees deja disponibles pour analyser plusieurs resultats en matiere de sante. Outre l'identification des questions a traiter lors du prochain cycle d'elaboration des politiques, nos conclusions ont contribue a la preparation d'une evaluation plus approfondie. [phrase omitted] Situacion Para priorizar las areas clave de intervencion e inversion para el proximo ciclo estrategico de planes nacionales de desarrollo (2026-2031) en Oman, necesitabamos una vision holistica del sistema sanitario del pais y de sus principales deficiencias e ineficiencias. Enfoque Teniendo en cuenta el marco de la Organizacion Mundial de la Salud, nuestro equipo, formado por siete funcionarios de los ministerios de sanidad nacionales y dos expertos internacionales, realizo una evaluacion rapida del funcionamiento del sistema sanitario. Utilizamos los datos ya disponibles para identificar los obstaculos del sistema y sus posibles causas, y verificamos nuestros resultados con entrevistas a informantes clave. Marco regional La poblacion de Oman, de 4,9 millones de habitantes, es relativamente joven (edad media: 28 anos) pero esta envejeciendo, con una carga creciente de enfermedades cronicas. Mientras que los servicios sanitarios son gratuitos para los ciudadanos omanies, mas de 1,5 millones de expatriados pagan de su bolsillo los servicios sanitarios. El fortalecimiento de la atencion primaria, la mejora de la calidad de la atencion, la proteccion financiera y la garantia de que los proveedores de atencion sanitaria publicos y privados operan dentro del mismo marco legal y de procedimiento se reconocen como prioridades nacionales clave. Cambios importantes Nuestra evaluacion destaco la necesidad de ampliar la cobertura de los servicios sanitarios a toda la poblacion, reforzar la gobernanza del sector sanitario privado, mejorar la educacion sanitaria, aumentar la inversion financiera y ampliar la capacidad de recopilacion y analisis de datos del pais. Lecciones aprendidas El marco de evaluacion nos ha permitido identificar las areas en las que falta informacion y utilizar los datos ya disponibles para analizar multiples resultados sanitarios. Ademas de identificar cuestiones que deben abordarse durante el proximo ciclo de elaboracion de politicas, nuestros resultados han contribuido a la preparacion de una evaluacion mas amplia., Introduction Health systems are constantly changing; regular wide-ranging assessments of their performance help to identify and adjust priorities, (1,2) and inform actions for their robust and resilient transformation. Originally developed [...]

This research is concerned with understanding the prespective of traditional healers on the integration of traditional medical practices in the Primary Health Care system in Sudan. Seven traditional healers in Khartoum State traditional centers were puposively selected and interviewed. Interviewes were conducted on the premises of the traditional health care. Data reflected that there is a variation on the health seeking behavior of men, women and children in relation to accessing traditional health seeking medicaiton. Quranic centers and sheikh fagir (a healer who assumes to use the quran to heal) centers are visited by women to seek fertility, and control marriage lives or prevent polygamy. Children are more prone to visit conventional medicine when they are physically ill, yet mental health is stigmatized by the Sudanese community as such children who are mentally distrubed seek traditional medicine and Quranic centers before getting in touch with conventional medicine. Diviners reported that most of their visitors are females. Generally speacking, men, prefer professional medicine for their health. For physical diseases city-men prefer to seek health through conventional medicine first when they fail to attain health they hunt for health in the traditional health. As such, traditional healers think that integrating traditional medicine within the Primary Health Care shortens the way, and save time, for health seekers because traditional health care providers can simply refer cases to conventional medicine when they decide that traditional medicine is incapable to deal with them in considerable short time. On the other hand, herbalists think that integration within the PHC will decrease their capacity to help others because of the rivilary with other similar specialization in the system such as pharamcology. Bonesetters as well think that they are complementing conventional medicine and can play a complementary role with conventional medicine if their art of health provision is intergrated with PHC, provided some capacity enhancement for the traditional health providers is introduced. keywords: Traditional medicine, conventional medicine, comeplimentary medicine, health care providers, Sudan [phrase omitted] [phrase omitted], Introduction The approach of using local resources and knowledge was advocated to be integrated in Primary health Care system (PHC). Under the WHO-endorsed policies, integration of traditional medicine (TRM) into [...]

The values of NAPCRG have been built upon participatory processes. The document, 'Responsible Research with Communities: Participatory Research in Primary Care,' (1) together with the recommendations for NAPCRG, was adopted [...]

PURPOSE To identify and quantify the barriers and facilitators to the use of clinical decision support systems (CDSSs) by primary care professionals (PCPs). METHODS A mixed-methods systematic review was conducted using a sequential synthesis design. PubMed/MEDLINE, PsycInfo, Embase, CINAHL, and the Cochrane library were searched in July 2021. Studies that evaluated CDSSs providing recommendations to PCPs and intended for use during a consultation were included. We excluded CDSSs used only by patients, described as concepts or prototypes, used with simulated cases, and decision supports not considered as CDSSs. A framework synthesis was performed according to the HOT-fit framework (Human, Organizational, Technology, Net Benefits), then a quantitative synthesis evaluated the impact of the HOT-fit categories on CDSS use. RESULTS A total of 48 studies evaluating 45 CDSSs were included, and 186 main barriers or facilitators were identified. Qualitatively, barriers and facilitators were classified as human (eg, perceived usefulness), organizational (eg, disruption of usual workflow), and technological (eg, CDSS user-friendliness), with explanatory elements. The greatest barrier to using CDSSs was an increased workload. Quantitatively, the human and organizational factors had negative impacts on CDSS use, whereas the technological factor had a neutral impact and the net benefits dimension a positive impact. CONCLUSIONS Our findings emphasize the need for CDSS developers to better address human and organizational issues, in addition to technological challenges. We inferred core CDSS features covering these 3 factors, expected to improve their usability in primary care. Key words: primary health care; information technology; medical informatics; quality of health care; decision support systems, clinical, INTRODUCTION Achieving best practice in primary care is a challenge because primary care professionals (PCPs) face a variety of health care issues and cannot always identify and access all the [...]

Conducting research in primary care during the COVID-19 pandemic is hard, due to baseline stresses on primary care, which have been compounded by the pandemic. We acknowledge and validate primary care researchers' frustrations. Using our experience on over 15 individual projects during the pandemic we identify 3 key challenges to conducting primary care research: (1) practice delivery trickle-down effects, (2) limited/changing resources and procedures for research, and (3) a generally tense milieu in US society during the pandemic. We present strategies, informed by a set of questions, to help researchers decide how to address these challenges observed during our studies. In order to overcome and grow from these challenging times we encourage normalization and self-compassion, and encourage researchers and funders to embrace pragmatic and adaptive research designs as the circumstances with COVID-19 evolve over time. https://doi.org/10.1370/afm.2889, INTRODUCTION Research has been difficult during the COVID-19 pandemic and may continue to be hard for quite a while. As researchers who are focused on studying primary care, we wrote [...]

PURPOSE Care continuity is foundational to the clinician/patient relationship; however, little has been done to operationalize continuity of care (CoC) as a clinical quality measure. The American Board of Family Medicine developed the Primary Care CoC clinical quality measure as part of the Measures That Matter to Primary Care initiative. METHODS Using 12-month Optum Clinformatics Data Mart claims data, we calculated the Bice-Boxerman Continuity of Care Index for each patient, which we rolled up to create an aggregate, physician-level CoC score. The physician quality score is the percent of patients with a Bice-Boxerman Index [greater than or equal to] 0.7 (70%). We tested validity in 2 ways. First, we explored the validity of using 0.7 as a threshold for patient CoC within the Optum claims database to validate its use for reflecting patient-level continuity. Second, we explored the validity of the physician CoC measure by examining its association with patient outcomes. We assessed reliability using signal-to-noise methodology. RESULTS Mean performance on the measure was 27.6%; performance ranged from 0% to 100% (n = 555,213 primary care physicians). Higher levels of CoC were associated with lower levels of care utilization. The measure indicated acceptable levels of validity and reliability. CONCLUSIONS Continuity is associated with desirable health and cost outcomes as well as patient preference. The CoC clinical quality measure meets validity and reliability requirements for implementation in primary care payment and accountability. Care continuity is important and complementary to access to care, and prioritizing this measure could help shift physician and health system behavior to support continuity. https://doi.org/10.1370/afm.2880, INTRODUCTION Continuity of care (CoC) is a central tenet of primary care and is associated with fewer hospitalizations and emergency department (ED) visits, better patterns of care utilization, lower costs [...]

The case study design is particularly useful for implementation analysis of complex health care innovations in primary care that can be influenced by the context of dynamic environments. Case studies may be combined with participatory approaches where academics conduct joint research with nonacademic stakeholders, to foster translation of findings results into practice. The aim of this article is to clarify epistemological and methodological considerations of case studies with a participatory approach. It also aims to propose best practice recommendations when using this case study approach. We distinguish between the participatory case study with full co-construction and co-governance, and the case study with a participatory approach whereby stakeholders are consulted in certain phases of the research. We then compare the epistemological posture of 3 prominent case study methodologists, Yin, Stake, and Merriam, to present the epistemological posture of case studies with a participatory approach. The relevance, applications, and procedures of a case study with a participatory approach methodology are illustrated through a concrete example of a primary care research program (PriCARE). We propose 12 steps for designing and conducting a case study with a participatory approach that may help guide researchers in the implementation analysis of complex health care innovations in primary care. Key words: case study; participatory approach; implementation; health care innovation; change, organizational; health services research; primary care, BACKGROUND Over the last 40 years, case study research has become increasingly popular and has evolved rapidly in many disciplines. By allowing in-depth analysis of complex phenomena in real-world contexts, [...]

Whether it's running among the saguaro cacti in Tucson, hiking up Mont Royal in Montreal, or listening to Bill Hogg play the drums, it's the moments with friends that we [...]