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244 results for “primary health care”
The Application of Machine Learning for Classification on Blood Pressure Variability. A New Approach for an Old Idea - Professor Kelvin Tsoi (The Chinese University of Hong Kong, School of Public Health and Primary Care)
<p>This video is the eighth talk from our Future Blood Testing Network Plus Launch that took place on the 23/11/2021.</p> <p>The Application of Machine Learning for Classification on Blood Pressure Variability. A New Approach for an Old Idea - Professor Kelvin Tsoi (The Chinese University of Hong Kong, School of Public Health and Primary Care)</p> <p>Bio: Professor Kelvin Tsoi is an Epidemiologist specialized in Digital Health. His research interests focus on digital innovation in chronic disease management, including mobile and telecare application for hypertension management, technological implementation and social engagement for cognitive screening, artificial intelligent application on electronic health records. He also works as the traditional epidemiologist on evidence-based medicine and population cohort studies. He obtained his Bachler Degree from Department of Statistics and Doctor of Philosophy from School of Public Health in the Chinese University of Hong Kong. He further received post-doctoral training in the Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics. He was also appointed as a Director of CUHK JC Bowel Cancer Education Centre to promote colorectal cancer screening. In 2011, he worked as a research scientist in Hospital Authority. He led projects covering a wide range of service areas on chronic diseases, such as service demand projection for schizophrenia and dementia. The experience of database management enhanced his understanding of the HA database structures. In 2013, he was invited to join the interdisciplinary team for Big Data research and worked closely with a team of engineers and data scientists. Currently, Professor Tsoi is an Associate Professor in JC School of Public Health and Primary Care, SH big Data Decision Analytics Research Centre and JC Institute of Ageing.</p> <p>Further details on this event can be found at: https://futurebloodtesting.org/event/23-11-21-future-blood-testing-network-launch/</p> <p>This video is an output from the Future Blood Testing Network which is funded by EPSRC under Grant Number EP/W000652/1</p> <p>YouTube Link: https://youtu.be/liLVKA-JHiI</p>
Resilience of primary health care facilities - experiences from 16 European countries during the Covid-19 pandemic. A mixed-methods study conducted by EURIPA.
<p><strong><span>Resilience of primary health care facilities – experiences from 16 European countries during the Covid-19 pandemic. A mixed-methods study conducted by EURIPA.</span></strong></p> <p><strong><span>Abstract</span></strong></p> <p><strong><span>Background</span></strong></p> <p><span>The role of primary care during a pandemic varies across European countries. The COVID-19 pandemic has altered the working practices of family medicine doctors. It has also impacted the resilience of health systems.</span></p> <p><strong><span>Objectives</span></strong><span> </span></p> <p><span>This study aimed to examine European health system responses to the pandemic, focusing on rural and urban differences.</span></p> <p><strong><span>Material and methods</span></strong></p> <p><span>This cross-sectional, mixed-methods study used a semi-structured online questionnaire with 68 questions, including 21 free-text comments. Data were collected from May 2020 to January 2021. Key informants from sixteen EURIPA member countries distributed questionnaires to 406 primary care doctors. Data were analyzed using descriptive statistics and non-parametric tests (Chi-square, Kruskal-Wallis, Mann-Whitney U) with a significance threshold of 0.05. </span></p> <p><strong><span>Results</span></strong></p> <p><span>A statistically significant difference was found between rural (36.4%, 55/151), semirural (19.4%, 24/124), and urban populations (29.8%, 39/131) regarding medicine shortages (χ² = 9.91, df = 4, p = 0.042). <span> </span>The semirural one proved to have a statistically significant difference with the other settings(chi-square post-hoc test, p = 0.004 in post-hoc chi-square test). Significant differences were found between countries in resilience features including, Effectiveness of triage, Adapting to the rapidly changing requirements, Government help, Existence of a community resilience group, Improved interprofessional collaboration, Medicine Shortage and GPs involved in palliative care.</span></p> <p><strong><span>Conclusions</span></strong></p> <p><span>Medicine shortage was more prevalent in rural and urban areas compared to semirural ones. Differences were observed between countries in their responses to the pandemic, particularly in Adapting to the rapidly changing requirements, Effectiveness of triage, Government help, Existence of a Community resilience group. Qualitative analysis confirmed these disparities.</span></p> <p><span>The results emphasize the need for tailored approaches considering diverse contexts in shaping effective health system resilience.</span></p>
Can we collect health-related quality of life information from anticoagulated atrial fibrillation participants who have recently experienced a bleed? An observational feasibility study in primary, and secondary care and through an online forum
<p>The purpose of the study was to evaluate the feasibility of recruiting participants diagnosed with atrial fibrillation (AF) taking oral anticoagulation therapies (OACs) and recently experiencing a bleed to collect health-related quality of life (HRQoL) information.</p> <p><strong>Design</strong></p> <p>Observational feasibility study. The study aimed to determine the feasibility of recruiting participants with minor and major bleeds, the most appropriate route for recruitment and the appropriateness of the Patient Reported Outcome Measures (PROMs) selected for collecting HRQoL information in AF patients, and the preferred format of the surveys.</p> <p><strong>Setting</strong></p> <p>Primary care, secondary care, and via an online patient forum.</p> <p><strong>Participants</strong></p> <p>The study population was adult patients (≥ 18) with Atrial Fibrillation (AF) taking oral anticoagulation therapies (OATs) who had experienced a recent major or minor bleed within the last four weeks.</p> <p><strong>Primary and Secondary outcome measures</strong></p> <p>Primary outcome:</p> <p>Patient reported outcome measures (PROMs): EuroQol 5 dimensions-5 levels (EQ-5D-5L); Perception of anticoagulant treatment questionnaire, part 2 only (PACT-Q, part 2); Atrial fibrillation effect on quality of life (AFEQT)</p> <p>Secondary outcomes:</p> <p>Location of bleed; bleed severity; current treatment; patient perceptions of HRQoLin relation to bleeding events.</p> <p><strong>Results</strong></p> <p>We received initial expressions of interest from 103 participants. We subsequently recruited 32 participants to the study- 14 from primary care and 18 through the AF forum. No participants were recruited through secondary care. Despite 32 participants consenting, only 26 initial surveys were completed. We received follow-up surveys from 11 participants (8 primary care and 3 AF forum). COVID-19 had a major impact on the study. </p> <p><strong>Conclusions</strong></p> <p>Primary care was the most successful route for recruitment. Most participants recruited to the study experienced a minor bleed. Further ways to recruit in secondary care should be explored, especially to capture more serious bleeds. </p> <p><strong>Registration</strong></p> <p>The study was adopted onto the NIHR Portfolio (I.D. #47771) and registered with www.ClinicalTrials.gov (#NCT04921176) in February 2021.</p> <p>Dataset contains all anonymised data for the participants who completed the survey including demographics, details of bleeds, co-morbidities and completed patient reported outcomes</p>
Collaborating to Heal Addiction and Mental Health in Primary Care
ClinicalTrials.gov study NCT04600414. IPD Sharing: YES. Countries: 1. Publications: 1.
A Transdiagnostic Course for Common Mental Health Problems in Primary Care
ClinicalTrials.gov study NCT04522713. IPD Sharing: NO. Countries: 1. Publications: 1.
Implementing Evidence-Based Mental Health Practices in Primary Care
ClinicalTrials.gov study NCT00996775. IPD Sharing: YES. Countries: 1. Publications: 3.
Knowledge of Primary Health Care Nurses at Selected Public Institutions Regarding Prescription of Antihypertensive Drugs
<p>Hypertension has been among the most studied topics of the previous century and has been one of the most significant comorbidities contributing to the development of stroke, myocardial infarction, heart failure, and renal failure. In the mist of that, there is limited data on nurses’ knowledge regarding prescription of antihypertensive drugs in Lesotho. The aim of this study was to assess primary health care nurses’ knowledge regarding prescription of antihypertensive drugs. Quantitative descriptive cross-sectional study of primary health care nurses recruited by purposive sampling was conducted. An electronic questionnaire was used to collect data and data were analyzed using descriptive statistics. Most participants were females and had attained diploma in general nursing and midwifery. A proportion of 26% fully knew the steps to be followed for diagnosing hypertension and only 23% felt highly confident to initiate patients on antihypertensive drugs. Moreover, knowledge on mechanism of action of antihypertensive drugs was poor and less than half only knew antihypertensive drug of choice when there is comorbidity. The study identified that nurses have knowledge deficit regarding prescription of antihypertensive drugs. There is a need for interventions to improve nurses’ knowledge so as to curb hypertension burden. </p>
Collaborative Perinatal Mental Health and Parenting Support in Primary Care
ClinicalTrials.gov study NCT02724774. IPD Sharing: NO. Countries: 1. Publications: 3.
Communicating Health Information and Improving Coordination With Primary Care
ClinicalTrials.gov study NCT03104543. IPD Sharing: YES. Countries: 1. Publications: 2.
Effect of Primary Care Education on Parents' Health-Related Perceptions and Attitudes
ClinicalTrials.gov study NCT07381088. IPD Sharing: NO. Countries: 1. Publications: 0.
Problem Management Plus (PM+) in Chile: a Pilot Randomized Controlled Trial of a Psychological Transdiagnostic Intervention Delivered in Primary Health Care
ClinicalTrials.gov study NCT06988332. IPD Sharing: NO. Countries: 1. Publications: 2.
Effectiveness of Electronic Health Record-Based Interventions for Improving Follow-Up in Primary Care
ClinicalTrials.gov study NCT01346839. IPD Sharing: Not stated. Countries: 1. Publications: 1.
Integrated Behavioral Health Prevention in Pediatric Primary Care for Infants
ClinicalTrials.gov study NCT04825210. IPD Sharing: YES. Countries: 1. Publications: 7.
An Evaluation of Innerview™, a Web-based Tool to Support the Integration of Mental Health in the Primary Care Setting
ClinicalTrials.gov study NCT02025647. IPD Sharing: Not stated. Countries: 1. Publications: 2.
Balance: A Pragmatic Trial of a Digital Health Intervention to Prevent Weight Gain in Primary Care
ClinicalTrials.gov study NCT03003403. IPD Sharing: NO. Countries: 1. Publications: 4.
PRescribing INterventions for Chronic Pain Via the Electronic Health Record Study - Primary Care Providers
ClinicalTrials.gov study NCT04601506. IPD Sharing: Not stated. Countries: 1. Publications: 1.
Novel health system strategies for tuberculin skin testing at primary care clinics: performance assessment and health economic evaluation.
<p>Datasets for journal paper.</p>
Data from: Primary care follow-up and measured mental health outcomes among women referred for ultrasound assessment of pain and/or bleeding in early pregnancy: a quantitative questionnaire study
Objectives To examine the extent of primary care follow-up and mental health outcomes among women referred for ultrasound assessment of pain and/or bleeding in early pregnancy, including those whose pregnancy is found to be viable on ultrasound assessment. Design Questionnaire study with prospective follow-up. Setting Urgent gynaecology clinic in secondary care, England. Participants 57 women participated in the study. Entry criteria: referral to the urgent gynaecology clinic with pain and/or bleeding in early pregnancy; gestation less than 16 weeks (the clinic's own 'cut-off'); no previous attendance at the clinic during the current pregnancy. Exclusion criteria: inability to understand English or to provide informed consent. Primary and secondary outcome measures Incidence of primary care follow-up among women referred to the urgent gynaecology clinic; incidence of women with measured mental health scores suggesting significant symptoms of distress. Results Fewer than 1 in 10 women referred for ultrasound assessment of pain and/or bleeding in early pregnancy had follow-up arrangements made with their general practitioner (GP). Most women who had GP follow-up found it helpful and a significant minority of women who did not have GP follow-up felt that it would have been helpful. Following ultrasound assessment, more than one-third of women had significant symptoms of distress. Symptoms of distress, particularly anxiety, were present among those women found to have viable pregnancies, as well as among those with non-viable pregnancies. Conclusions GPs are advised to consider offering follow-up to all women referred for ultrasound assessment of pain and/or bleeding in early pregnancy. Researchers in this area are advised to consider the experiences of women with pain and/or bleeding in early pregnancy whose pregnancies are ultimately found to be viable on ultrasound scan.
Data from: Screening primary-care patients forgoing health care for economic reasons
Background: Growing social inequities have made it important for general practitioners to verify if patients can afford treatment and procedures. Incorporating social conditions into clinical decision-making allows general practitioners to address mismatches between patients' health-care needs and financial resources. Objectives: Identify a screening question to, indirectly, rule out patients' social risk of forgoing health care for economic reasons, and estimate prevalence of forgoing health care and the influence of physicians' attitudes toward deprivation. Design: Multicenter cross-sectional survey. Participants: Forty-seven general practitioners working in the French–speaking part of Switzerland enrolled a random sample of patients attending their private practices. Main Measures: Patients who had forgone health care were defined as those reporting a household member (including themselves) having forgone treatment for economic reasons during the previous 12 months, through a self-administered questionnaire. Patients were also asked about education and income levels, self-perceived social position, and deprivation levels. Key Results: Overall, 2,026 patients were included in the analysis; 10.7% (CI95% 9.4-12.1) reported a member of their household to have forgone health care during the 12 previous months. The question "Did you have difficulties paying your household bills during the last 12 months" performed better in identifying patients at risk of forgoing health care than a combination of four objective measures of socio-economic status (gender, age, education level, and income) (R2=0.184 vs. 0.083). This question effectively ruled out that patients had forgone health care, with a negative predictive value of 96%. Furthermore, for physicians who felt powerless in the face of deprivation, we observed an increase in the odds of patients forgoing health care of 1.5 times. Conclusion: General practitioners should systematically evaluate the socio-economic status of their patients. Asking patients whether they experience any difficulties in paying their bills is an effective means of identifying patients who might forgo health care.
Data from: Detection and initial management of gestational diabetes through primary health care services in Morocco: an effectiveness-implementation trial
Background: Gestational Diabetes Mellitus (GDM) testing and management in Morocco is associated with delays resulting in late commencement of treatment. To reduce delays and to increase access of women to GDM care, a country-adapted intervention targeting primary health care providers was designed to test the hypothesis that detection and initial management of GDM at the primary level of care improves newborn outcomes in terms of lower birthweights and less cases of macrosomia and impacts on maternal weight gain, glucose balance and pregnancy outcomes. Materials and methods: We conducted a cluster randomized controlled trial in two districts of Morocco. In each district, 10 health centers were randomly selected to serve either as intervention or control sites. Pregnant women attending antenatal care in the study facilities were eligible to participate. At the intervention sites, women were offered GDM screening by capillary glucose testing following International Association of Diabetes in Pregnancy Study Groups/WHO criteria. Women diagnosed with GDM received counselling on nutrition and exercise and were followed up through their health center whereas at control facilities routine practice was applied. Primary outcome was birthweight and secondary outcomes maternal weight gain, glucose control and pregnancy complications. We further assessed GDM prevalence in the intervention arm. Statistical analysis was performed on 210 recruited women. Continuous variables were reported using means while categorical variables using frequencies with tests of independence applying chi-squared tests. Differences of outcome variables between the two groups were estimated by mixed-effects regression models and effect sizes adjusted for confounders. The trial is registered under NCT02979756 at ClinicalTrials.gov. Results: GDM prevalence reached 23.7% in Marrakech. Birthweight in the intervention group was 147grams lower than in the control group (p = 0.08) as was the proportion of macrosomes (3.5% versus 18.4%; p< 0.001). In the intervention arm, women did two times more follow-ups than at control sites (p = 0.001) and mean follow-up intervals were shorter (11.3 days versus 18.7 days; p < 0.001). Overall, 30% more fasting blood sugar values were balanced (p = 0.005) and mean weekly maternal weight gain 49 grams lower (p = 0.032) in the intervention group. More women from control facilities had a delivery complication whereas more newborn complications were observed in women from intervention facilities. No difference between the two groups existed regarding mode of delivery and mean gestational age at delivery. One of the main limitations of the study was the Hawthorn-effect at control sites that might have led to an underestimation of the effect size. Conclusion: A high GDM prevalence in Morocco calls for a context-adapted screening and management approach to enable early interventions. GDM detection and care through antenatal care at primary health facilities may have positively impacted on newborn birthweight but findings are inconclusive. Results of this study will contribute to the decision on a potential upscaling of the intervention in Morocco. Future research could examine long term metabolic changes including diabetes type 2 in the cohort of women and their children.
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