ABSTRACT
Health systems built based on primary health care are fundamental to succeeding universal health coverage. Well-organised primary healthcare services can play a basic role in improving population health as well as the well-being of the population. Although significant improvements in the health outcomes of the global population during the era of the Millennium Development Goals, nearly half of the population cannot access the health services, they need. Health is central to the 2030 Agenda for Sustainable Development as it relates to many of the Sustainable Development Goals and is the specific focus of Goal 3. Outbreaks of global pandemics or emergencies like COVID-19 are the biggest challenges to the 'resilience' of primary care systems. Therefore, countries need to establish a regular system of facility assessments to provide objective measures for evaluating the health services' availability, readiness, quality, including measures to evaluate preparedness and response capacities. Barbara Starfield was the first author to explore the context of primary care organisation (PCO). She mentioned that organisation of primary care includes four main primary care domains: first-contact care, comprehensiveness, continuity, and coordination. In 2008 Hogg et al., proposed that the conceptual framework for PCO consists of structural and performance domains and this domain classification influenced new authors on the subject until today. The structural domain includes three components;the health care system, the practice context and the organisation of the practice;and the performance domain includes two components;healthcare service delivery and technical quality of clinical care. According to Kringos et al., the structure of primary care consists of three dimensions: primary care governance, financing of primary care and primary care workforce development. They determined the primary care process by four dimensions: accessibility of primary care, comprehensiveness of primary care;continuity of primary care;and coordination of primary care. Senn et al., proposed a consolidated framework, which is particularly beneficial for primary care organisations designing and implementing well-defined monitoring activities. With the addition socio-cultural, economic and biological contexts, the framework became multidimensional and in-depth. Inclusion of needs and outcomes of patients and the population has the potential to cover the productivity of the given organisation. Strong primary care requires well-developed organisational planning between levels of care. Primary care-oriented health systems are required to effectively handle the unmet health needs of the population. An efficient primary care organisation is very important for achieving a primary care-oriented health system. In this keynote, PCO's key aspects and benchmarks will be explored based on previously mentioned frameworks and domains. As an example of health systems in transition, Turkey and Azerbaijan are reforming their health systems, including primary care services. Turkey has completed the implementation of several interventions in the structural component of primary care, however, there is still room for development in the process components. Azerbaijan has established a state health insurance scheme and set up family health centres as primary care facilities serving a defined population. However, serious structural reforms are still needed for a functional primary care service accessible to the whole nation. This keynote will also cover more information on recent primary care reforms in both countries. The frameworks provided above will serve as tools for analysing primary care in these countries.
ABSTRACT
Background and Aim: COVID-19 pandemic may cause major attitude and behavioral changes, especially in the elderly population. We aimed to examine the attitude changes of the geriatric population who previously had received training on cardiovascular health in the first three (stay-at-home) months of COVID-19 pandemic in Turkey. Method(s): This cross-sectional study was a questionnaire conducted with >=65-year-old attendees of daycare centers/nursing homes in certain municipalities in Istanbul city, via telephone interviews during COVID-19 pandemic's stay-at-home period. The participants had previously attended a structured awareness and training program on atrial fibrillation risk factors and a heart healthy life style project (WebsAFIs;know your heart rhythm) that was held just before the pandemic. The nurses of the project were in touch with attendees during the pandemic and kept on giving advices on heart heathy living. The questionnaire was conducted during the pandemic and health-related attitudes of the participants were described and compared based on their age group and clinical conditions. Result(s): Women constituted 66.3% of the participants and the mean age was 71.6+/-4.4 years. We detected that 60.6% of the respondents had hypertension, 26.0% diabetes, and 21.2% vascular disease. The mean body mass indices in March (28.2+/-3.8 kg/m2) and June (28.5+/-4.0 kg/m2) were similar (p>0.05). Those who would/did not do exercise increased from pre-pandemic 12.5% to 46.2% (p<0.01) during stay-at-home period, which did not differ based on the age group or examined medical conditions. More diabetic patients stated to have unhealthier diet than their non-diabetic counterparts during stay-at-home period (25.9% and 9.1%, respectively;p<0.02). Half of the respondents (50.5%) stated that they were very much worried about the health of their relatives. Near third-quarter (73.1%) of participants were using cardiovascular system drugs whereas 34.6% were using vitamin/mineral/food supplements. Conclusion(s): Though the exercise habits of the geriatric population appear to change negatively, no serious problems tend to exist regarding nutrition, cardiovascular health, and healthcare utilization. Body weight was also maintained in spite of decreased activity. The results of the questionnaire in this select group with a previous training on cardiovascular awareness just before the pandemic underlines the importance of patient empowerment in cardiovascular prevention.