Senses and meanings of primary health care academic visions in nursing / Sentidos y significados de las visiones académicas de la atención/cuidado primaria de salud en enfermería / Sentidos e significados das visões acadêmicas da atenção básica/cuidado em enfermagem

Introduction: Primary Health Care (PHC) has acquired different meanings for different people, at specific times and places, which poses important challenges for its understanding. Objective: To analyze the meaning(s) and sense(s) of Primary/Basic Health Care in the academic views on Nursing/Health in the context of undergraduate Nursing courses offered at two public Higher Education Institutions. Materials and methods: Qualitative study with an exploratory approach. Semi-structured interviews and documentary analysis were used as data collection techniques. Results: The senses/meanings of Primary Health Care converge with the population's gateway to the health system at the first care level and with the first contact of a person with the health service. However, it is still considered as a less important service within the care network. Conclusion: Primary Health Care means a relevant possibility for Nursing/Health care through health promotion and disease prevention actions, with a commitment to respond to most of the population's health needs.

Introducción: La Atención Primaria de Salud ha adquirido diferentes significados para diversas personas, en momentos y lugares específicos, lo cual plantea importantes retos para su entendimiento. Objetivo: Analizar los significados y sentidos de la Atención Primaria de Salud desde una visión académica en Enfermería y en el contexto de cursos de pregrado en Enfermería ofrecidos en dos Instituciones Públicas de Educación Superior. Materiales y métodos: Estudio cualitativo con un enfoque exploratorio, para la recolección de datos se emplearon entrevistas semiestructuradas y análisis documental de contenidos. Resultados: Los sentidos/significados de la Atención Primaria de la Salud convergen con el ingreso de la población al sistema de salud en el primer nivel de atención y la primera experiencia de la persona con el servicio de salud. Sin embargo, dicha Atención Primaria todavía se considera un servicio de baja importancia dentro de la red asistencial. Conclusión: La Atención Primaria de Salud representa una posibilidad relevante para el cuidado de Enfermería a través de acciones de promoción de la salud y prevención de enfermedades, que debe fortalecerse para responder la mayoría de las necesidades de salud de la población.

Introdução: A Atenção Primária à Saúde tem adquirido diferentes significados para diferentes pessoas, em momentos e locais específicos, o que coloca desafios importantes para a sua compreensão. Objetivo: Analisar os sentidos e significados da Atenção Primária à Saúde na perspectiva acadêmica em Enfermagem e no contexto dos cursos de graduação em Enfermagem oferecidos em duas Instituições de Ensino Superior Públicas. Materiais e métodos: Estudo qualitativo com abordagem exploratória, utilizou-se entrevistas semiestruturadas para coleta de dados e análise de conteúdo documental. Resultados: Os sentidos/significados da Atenção Primária à Saúde convergem com a entrada da população no sistema de saúde no primeiro nível de atenção e a primeira experiência da pessoa com o serviço de saúde. Contudo, a referida Atenção Básica ainda é considerada um serviço de baixa importância dentro da rede de saúde. Conclusão: A Atenção Primária à Saúde representa uma possibilidade relevante para o cuidado de Enfermagem por meio de ações de promoção da saúde e prevenção de doenças, que devem ser fortalecidas para responder à maioria das necessidades de saúde da população.

Strengthening care for noncommunicable diseases in the Americas

Noncommunicable diseases (NCDs), such as cardiovascular diseases, cancer, respiratory diseases and diabetes, account for 81% of lives lost in the Americas. An estimated 240 million adults in the Region live with at least one NCD, requiring access to continuous support, delivered through Primary Health Care. Successful implementation of NCD policies and interventions can result in significant cost savings, alleviating the economic burden on healthcare systems, individuals, and society, while effective NCD management at the Primary Health Care level reduces premature deaths and disabilities. Strengthening integration of NCDs into Primary Health Care represents a key milestone in a country’s health system response to the Sustainable Development Agenda, with the aim of leaving no-one behind.

Protecting and promoting mental health in the Americas

Mental disorders, such as anxiety and depression, and psychoactive substance use-related disorders, such as alcohol or tobacco abuse, affect people all over the world and contribute to an important burden of disease. The Americas is no exception. The Region has high prevalence rates of anxiety and depressive disorders, and has experienced a considerable increase in recent years of people living with dementia, the third leading cause of death in the Region in 2019. The COVID-19 pandemic exacerbated mental health issues and brought them into the spotlight. Latin America and the Caribbean saw a deterioration in mental health at the population level with prevalences of major depressive and anxiety disorders rising by 35% and 32%, respectively, in 2020. Some groups were disproportionately affected, such as health and frontline workers, women, young people, individuals with preexisting mental health conditions, ethnic minorities, and those living in situations of vulnerability. There is a lack of access to quality services for mental health conditions in many countries. Furthermore, these services are underfinanced; public spending on mental health is only about 3% of the health budget. The Pan American Health Organization (PAHO) has urged all Member States to promote increased investment in mental health services.

Hearts: Paquete técnico para la gestión de las enfermedades cardiovasculares en la atención primaria de salud. Sistemas de monitoreo

El paquete técnico HEARTS proporciona un enfoque estratégico para mejorar la salud cardiovascular en los países. Consta de seis módulos y una guía de implementación para apoyar a los ministerios de salud a fortalecer el manejo de las enfermedades cardiovasculares en los entornos de atención primaria de salud. Los módulos contienen instrucciones e información práctica y estan respaldados por un documento técnico general que proporciona la lógica que justifica marco y enfoque integrado para la gestión de las enfermedades no transmisibles.

Evaluación de la implementación de la iniciativa HEARTS en una comunidad rural de Venezuela, 2023 / Evaluation of Implementation of the HEARTS Initiative in a Rural Community in Venezuela, 2023 / Avaliação da implementação da iniciativa HEARTS em uma comunidade rural da Venezuela, 2023

[RESUMEN]. Objetivo. Evaluar la implementación de estrategias de la iniciativa HEARTS en una comunidad de la República Bolivariana de Venezuela. Métodos. Estudio cuasiexperimental, con la evaluación de la cascada de cuidado, factores impulsores e índices de madurez y desempeño cuatro meses después de la implementación de la iniciativa HEARTS en la comunidad La Marroquina en 52 pacientes con hipertensión (HTA). Los datos se procesaron en el programa SPSS® versión 25.0. Se aplicaron las pruebas t-Student y de ji cuadrado para determinar la significancia estadística. Resultados. Completaron los cuatro meses de seguimiento 50 pacientes, 63,5% con baja escolaridad y estrato socioeconómico bajo o muy bajo. Al inicio, 11,5% estaba controlado, y 40,4% inició con monoterapia. Al cuarto mes, 100% de las personas hipertensas recibieron el diagnóstico, 92% recibió tratamiento y 52% alcanzó la meta de control de HTA. El 72% recibía terapia combinada. De las personas hipertensas, 70% mantenía cifras de presión arterial <140/90 mmHg. El índice de madurez alcanzó nivel 4 de 5, y el índice de desempeño se clasificó en incipiente. Conclusión. Este trabajo muestra, en un corto tiempo, un buen índice de madurez en la implementación de un protocolo estandarizado de diagnóstico, tratamiento y seguimiento de la HTA en una población rural, por parte de personal médico y no médico supervisado, que mejora las tasas de diagnóstico, tratamiento y control en los hipertensos, y empieza a mostrar su desempeño. El mantenimiento de esta iniciativa tendrá un gran impacto en la salud de esta población. Se recomienda su implementación como política de salud pública nacional.

[ABSTRACT]. Objective. To evaluate the implementation of HEARTS strategies in a community in the Bolivarian Republic of Venezuela. Methods. Quasi-experimental study evaluating the cascade of care, driving factors, and maturity and performance indicators four months after implementation of the HEARTS initiative in 52 patients with high blood pressure (BP) in the community of La Marroquina. The data were processed using SPSS® Statistics, version 25.0. Student's t-distribution and chi-square tests were applied to determine statistical significance. Results. Fifty patients, 63.5% of them with a low educational level and low or very low socioeconomic status, completed the four-month monitoring period. At baseline, 11.5% had controlled BP and 40.4% initiated monotherapy. By the fourth month, 100% of patients with high BP had been diagnosed, 92% had received treatment, and 52% had achieved control of their BP. Seventy-two percent were receiving combined therapy. Seventy percent of the hypertensive individuals maintained blood pressure levels <140/90 mmHg. The maturity index score was 4 of 5, and the performance index was classified as incipient. Conclusion. This work shows that, in a short time, a good maturity index was achieved through the implementation, by medical and supervised non-medical personnel, of a standardized protocol for diagnosis, treatment, and monitoring of high blood pressure in a rural population. Rates of diagnosis, treatment, and BP control improved, with incipient performance results. Sustaining this initiative will have a major impact on the health of this population. Its implementation as a national public health policy is recommended.

[RESUMO]. Objetivo. Avaliar a implementação das estratégias da iniciativa HEARTS em uma comunidade da República Bolivariana da Venezuela. Métodos. Estudo quase-experimental que avaliou a cascata de cuidados, fatores determinantes e índices de maturidade e desempenho quatro meses após a implementação da iniciativa HEARTS na comunidade de La Marroquina, Venezuela. Foram avaliados 52 pacientes com hipertensão arterial. A análise estatística foi realizada no software SPSS®, versão 25.0. O teste t de Student e o teste qui-quadrado foram usados para determinar a significância estatística. Resultados. Cinquenta pacientes completaram o acompanhamento de quatro meses. Desses, 63,5% tinham baixa escolaridade e nível socioeconômico baixo ou muito baixo. No início do estudo, 11,5% apresentavam doença controlada e 40,4% estavam em monoterapia. No quarto mês, 100% dos pacientes com hipertensão arterial haviam sido diagnosticados, 92% haviam recebido tratamento, 52% haviam atingido a meta de controle da hipertensão e 72% estavam recebendo terapia combinada. Dos pacientes com hipertensão, 70% mantinham níveis pressóricos <140 × 90 mmHg. O índice de maturidade foi avaliado como nível 4 (de 5), e o desempenho foi classificado como incipiente. Conclusão. Este estudo demonstra, após pouco tempo, um bom índice de maturidade na implementação de um protocolo padronizado de diagnóstico, tratamento e acompanhamento da hipertensão arterial em uma população rural atendida por pessoal médico e não médico supervisionado. Observa-se melhoria das taxas de diagnóstico, tratamento e controle dos pacientes com hipertensão, demonstrando de forma incipiente seu desempenho. Dar continuidade a essa iniciativa terá uma repercussão importante na saúde dessa população. Recomendando-se que a iniciativa seja implementada como política nacional de saúde pública.

Aportes y desafíos en el proceso de reforma del sector salud con énfasis en territorios prioritarios: Colombia 2022

En coherencia con los planes del Gobierno nacional, la Asociación Colombiana de Salud Pública, con apoyo de la Alianza Académica Nacional Presente y Futuro de la Salud Pública y su grupo especializado en Atención Primaria de la Salud, por solicitud y en coordinación con la Organización Panamericana de la Salud (OPS) en Colombia desarrollan una propuesta que contribuye al mejoramiento de la salud de la población colombiana en los departamentos con mayores desigualdades de acceso a los servicios de salud. La transición democrática que vive Colombia es una oportunidad para presentar iniciativas de este tipo que permitan reforzar y transformar las condiciones de acceso a servicios de salud y el desarrollo de programas integrales e integrados de salud pública en los departamentos prioritarios y con mayores desigualdades, tales como Nariño, Amazonas, Vichada y Caquetá. La Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS), en acuerdo con las autoridades nacionales y territoriales, establecerá los criterios para seleccionar los departamentos e implementar la propuesta según factibilidad y viabilidad técnica financiera. Este libro busca contribuir con elementos analíticos y propuestas prácticas y se orienta a: fortalecer la autoridad sanitaria y la gobernanza de la salud pública; mejorar la capacidad resolutiva del sistema en relación a los determinantes sociales, la prevención, el cuidado y la atención primaria de los problemas y necesidades de la salud; seleccionar y capacitar a los equipos interdisciplinarios de salud garantizando su contratación y estabilidad laboral y generando una red de universidades e institutos tecnológicos dispuestos y con capacidad de dar soporte a la transformación del sistema de salud en los territorios más vulnerables de Colombia. Cada uno de los capítulos de este libro desarrolla una serie de pasos a seguir para lograr un cambio a escala que acelere intervenciones participativas con el propósito de cerrar la brecha de acceso a los servicios de salud y brindar soluciones a necesidades y problemas estructurales que condicionan los modos de producción y de vida en cada territorio. Para dar viabilidad al desarrollo e implementación del nuevo modelo de salud en Colombia, se hace necesaria una propuesta de soporte técnico financiero. Este contenido se pone a disposición del Ministerio de Salud y Protección Social con la expectativa de que pueda integrarse en sus consideraciones para enfrentar el desafío de la reforma de la salud propuesta y como base para establecer una relación sinérgica que viabilice el alcance de las grandes metas de acceso universal a la salud para la población colombiana.

Effectiveness of post-COVID-19 primary care attendance in improving survival in very old patients with multimorbidity: a territory-wide target trial emulation.

OBJECTIVES: Older individuals with multimorbidity are at an elevated risk of infection and complications from COVID-19. Effectiveness of post-COVID-19 interventions or care models in reducing subsequent adverse outcomes in these individuals have rarely been examined. This study aims to examine the effectiveness of attending general outpatient within 30 days after discharge from COVID-19 on 1-year survival among older adults aged 85 years or above with multimorbidity. DESIGN: Retrospective cohort study emulating a randomised target trial using electronic health records. SETTING: We used data from the Hospital Authority and the Department of Health in Hong Kong, which provided comprehensive electronic health records, COVID-19 confirmed case data, population-based vaccination records and other individual characteristics for the study. PARTICIPANTS: Adults aged 85 years or above with multimorbidity who were discharged after hospitalisation for COVID-19 between January 2020 and August 2022. INTERVENTIONS: Attending a general outpatient within 30 days of last COVID-19 discharge defined the exposure, compared to no outpatient visit. MAIN OUTCOME MEASURES: Primary outcome was all-cause mortality within one year. Secondary outcomes included mortality from respiratory, cardiovascular and cancer causes. RESULTS: A total of 6183 eligible COVID-19 survivors were included in the analysis. The all-cause mortality rate following COVID-19 hospitalisation was lower in the general outpatient visit group (17.1 deaths per 100 person-year) compared with non-visit group (42.8 deaths per 100 person-year). After adjustment, primary care consultations within 30 days after discharge were associated with a significantly greater 1-year survival (difference in 1-year survival: 11.2%, 95% CI 8.1% to 14.4%). We also observed significantly better survival from respiratory diseases in the general outpatient visit group (difference in 1-year survival: 6.3%, 95% CI 3.5% to 8.9%). In a sensitivity analysis for different grace period lengths, we found that the earlier participants had a general outpatient visit after COVID-19 discharge, the better the survival. CONCLUSIONS: Timely primary care consultations after COVID-19 hospitalisation may improve survival following COVID-19 hospitalisation among older adults aged 85 or above with multimorbidity. Expanding primary care services and implementing follow-up mechanisms are crucial to support this vulnerable population's recovery and well-being.

Postpartum Primary Care Engagement Using Default Scheduling and Tailored Messaging: A Randomized Clinical Trial.

Importance: More than 30% of pregnant people have at least 1 chronic medical condition, and nearly 20% develop gestational diabetes or pregnancy-related hypertension, increasing the risk of future chronic disease. While these individuals are often monitored closely during pregnancy, they face major barriers when transitioning to primary care following delivery, due in part to a lack of health care support for this transition. Objective: To evaluate the impact of an intervention designed to improve postpartum primary care engagement by reducing patient administrative burden and information gaps. Design, Setting, and Participants: An individual-level randomized clinical trial was conducted from November 3, 2022, to October 11, 2023, at 1 hospital-based and 5 community-based outpatient obstetric clinics affiliated with a large academic medical center. Participants included English- and Spanish-speaking pregnant or recently postpartum adults with obesity, anxiety, depression, diabetes, chronic hypertension, gestational diabetes, or pregnancy-related hypertension and a primary care practitioner (PCP) listed in their electronic health record. Intervention: A behavioral economics-informed intervention bundle, including default scheduling of postpartum PCP appointments and tailored messages. Main Outcome and Measures: Completion of a PCP visit for routine or chronic condition care within 4 months of delivery was the primary outcome, ascertained directly by reviewing the patient's electronic health record approximately 5 months after their estimated due date. Intention-to-treat analysis was conducted. Results: A total of 360 patients were randomized (control, 176; intervention, 184). Individuals had a mean (SD) age of 34.1 (4.9) years and median gestational age of 36.3 (IQR, 34.0-38.6) weeks at enrollment. The distribution of self-reported race and ethnicity was 6.8% Asian, 7.4% Black, 68.6% White, and 15.0% multiple races or other. Most participants (75.4%) had anxiety or depression, 16.1% had a chronic or pregnancy-related hypertensive disorder, 19.5% had preexisting or gestational diabetes, and 40.8% had a prepregnancy body mass index of 30 or greater. Medicaid was the primary payer for 21.2% of patients. Primary care practitioner visit completion within 4 months occurred in 22.0% (95% CI, 6.4%-28.8%) of individuals in the control group and 40.0% (95% CI, 33.1%-47.4%) in the intervention group. In regression models accounting for randomization strata, the intervention increased PCP visit completion by 18.7 percentage points (95% CI, 9.1-28.2 percentage points). Intervention participants also had fewer postpartum readmissions (1.7% vs 5.8%) and increased receipt of the following services by a PCP: blood pressure screening (42.8% vs 28.3%), weight assessment (42.8% vs 27.7%), and depression screening (32.8% vs 16.8%). Conclusions and Relevance: The findings of this randomized clinical trial suggest that the current lack of support for postpartum transitions to primary care is a missed opportunity to improve recently pregnant individual's short- and long-term health. Reducing patient administrative burdens may represent relatively low-resource, high-impact approaches to improving postpartum health and well-being. Trial Registration: ClinicalTrials.gov Identifier: NCT05543265.

Development and psychometric evaluation of a questionnaire for the assessment of depression in primary care: a cross-sectional study.

OBJECTIVES: To develop a new questionnaire for the diagnostic assessment of depression adapted to the primary care setting by combining psychiatric criteria and heuristics of general practitioners (GPs). Psychometric evaluation of the new questionnaire and first validity evidence. DESIGN: The questionnaire was developed using cognitive interviews with think-aloud technique. Factorial validity was then examined in a cross-sectional study. SETTING: Primary care. Five general practices in Bavaria, Germany. PARTICIPANTS: 15 GPs, 4 psychiatrists/psychotherapists and 13 patients participated in cognitive expert interviews. A primary care sample of N=277 consecutive patients participated in the cross-sectional study. METHODS: After consultation with experts and literature research, the questionnaire contained a self-rating part for patients and an external part for GPs. Items were then iteratively optimised using cognitive interviews. Factorial validity was examined. To estimate internal consistency, Cronbach's α was calculated. Validity was assessed by correlating the new questionnaire and the Patient Health Questionnaire-9 (PHQ-9). RESULTS: The preliminary version of the two-part 'Questionnaire for the assessment of DEpression SYmptoms in Primary Care' (DESY-PC) comprised 52 items for patients (DESY-PAT-1: questions about patient's environment; DESY-PAT-2: questions about depression-specific symptoms) and 21 items for GPs (DESY-GP). The analysis of the DESY-PAT-1 revealed a one-factor solution ('environmental factors') with Cronbach's α of 0.55. The items of the DESY-PAT-2 were assigned to three factors, 'depressive cognitions', 'suicidality' and 'symptoms of fatigue', with Cronbach's α of 0.86, 0.79 and 0.85, respectively. Factorial analysis revealed two factors for the DESY-GP: 'depression symptoms' and 'medical history/external factors'. Cronbach's α was 0.90 and 0.59, respectively. After factorial analysis, the DESY-PAT was reduced to 28 items, and the DESY-GP was reduced to 15 items. Correlations of the DESY-PC with the PHQ-9 were high and significant, indicating convergent validity. CONCLUSIONS: The new questionnaire represents an innovative extension of depression questionnaires and could be particularly suitable for general practices.

Evaluating the Effectiveness of the COPD Assessment Test (CAT) in Screening for Chronic Obstructive Pulmonary Disease.

Background: Chronic obstructive pulmonary disease (COPD) is a major public health problem that remains largely under-diagnosed, mainly due to the under-use of spirometry to establish the diagnosis. The aim of this study is to evaluate the effectiveness of the Moroccan Arabic dialect version of the COPD Assessment Test (CAT) in screening for COPD. Methods: This was a cross-sectional study carried out in primary care facilities in Morocco, involving participants aged 40 and over. The performance of CAT in detecting cases of COPD was measured with reference to the results of spirometry, considered to be the gold Standard. Results: A total of 477 participants were included in the study. The prevalence of COPD was 6.7%. Internal consistency of the Moroccan Arabic dialect version of the CAT was high, with a Cronbach's alpha of 0.89. The total score of the CAT and of each item was significantly higher in subjects with COPD than in those without (P=0.000). Significantly negative correlations were found between CAT total score and FEV1 (r = -0.33, p=0.000), CAT and FVC (r = -0.22, p=0.000), CAT and FEV1/FVC ratio (r = -0.22, p=0.000). The receiver operating characteristic curve showed an area under the curve of 0.93. A CAT score of 10 was the optimal cut-off value for COPD screening, with a sensitivity, specificity, positive predictive value, and negative predictive value of 78.1%, 93.9%, 48.1% and 98.4%, respectively. Conclusion: The results of the present study showed that the CAT could be used as a screening tool for COPD. The use of this tool by healthcare professionals in primary care settings will improve and promote early diagnosis of this chronic disease.

'Important, but difficult': Swedish primary care professionals' perceptions and experiences of dealing with violence against women: an interview study.

BACKGROUND: Men's violence against women is a global health problem causing physical, mental, sexual and reproductive ill-health. The World Health Organisation has estimated that every third woman in the world has been exposed to physical and/or sexual violence. Swedish primary care is central for victims of violence, as it is normally the first port of call for seeking healthcare. This requires professional competence on violence, and its causes. It also requires resources for working with violence prevention, disclosure and supportive actions. The aim of this study is to deepen the understanding of how primary care professionals in Sweden deal with violence against women. We analyse their viewpoints, experiences and practices of working with violence as a health problem, and especially if, and if so how, they ask patients about violence. METHODS: A qualitative, explorative research design was adopted. Research interviews were conducted with 18 health professionals at eight primary care clinics. These clinics were located in four different regions, from the south to the north, in large urban areas, middle-size cities and rural areas. The interviews were voice recorded and transcribed verbatim. Thematic analysis was used to analyse the interviews. RESULTS: Three themes, with a total of ten related sub-themes, were developed. These themes are: (a) Varying understandings and explanations of violence against women; (b) The tricky question of asking about violence; and (c) Multiple suggestions for improving primary care's work with violence against women. The awareness of violence varied considerably, with some practitioners being highly knowledgeable and having integrated violence into their everyday practice, whereas others were less knowledgeable and had not paid much attention to violence. The very naming of violence seemed to be problematic. Several suggestions for improvements at professional, managerial and organisational levels were articulated. CONCLUSIONS: The results shed important light on the professionals' problems and struggles when dealing with violence against women in primary care. Better support and resources from the healthcare organisation, clearer leadership and more detailed policy would improve and facilitate everyday practice. All of these factors are indispensable for primary care's work with victims of men's violence against women.

An Approach to Potentially Increasing Adoption of an Artificial Intelligence-Enabled Electronic Medical Record Encounter in Canadian Primary Care: Protocol for a User-Centered Design.

BACKGROUND: Primary care physicians are at the forefront of the clinical process that can lead to diagnosis, referral, and treatment. With electronic medical records (EMRs) being introduced and, over time, gaining acceptance by primary care users, they have now become a standard part of care. EMRs have the potential to be further optimized with the introduction of artificial intelligence (AI). There has yet to be a widespread exploration of the use of AI in primary health care and how clinicians envision AI use to encourage further uptake. OBJECTIVE: The primary objective of this research is to understand if the user-centered design approach, rooted in contextual design, can lead to an increased likelihood of adoption of an AI-enabled encounter module embedded in a primary care EMR. In this study, we use human factor models and the technology acceptance model to understand the results. METHODS: To accomplish this, a partnership has been established with an industry partner, TELUS Health, to use their EMR, the collaborative health record. The overall intention is to understand how to improve the user experience by using user-centered design to inform how AI should be embedded in an EMR encounter. Given this intention, a user-centered approach will be used to accomplish it. The approach of user-centered design requires qualitative interviewing to gain a clear understanding of users' approaches, intentions, and other key insights to inform the design process. A total of 5 phases have been designed for this study. RESULTS: As of March 2024, a total of 14 primary care clinician participants have been recruited and interviewed. First-cycle coding of all qualitative data results is being conducted to inform redesign considerations. CONCLUSIONS: Some limitations need to be acknowledged related to the approach of this study. There is a lack of market maturity of AI-enabled EMR encounters in primary care, requiring research to take place through scenario-based interviews. However, this participant group will still help inform design considerations for this tool. This study is targeted for completion in the late fall of 2024. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54365.

Comorbidities and use of health services in people with diabetes mellitus according to risk levels by adjusted morbidity groups.

BACKGROUND: People with diabetes mellitus frequently have other comorbidities and involve greater use of primary and hospital care services. The aim of this study was to describe the comorbidities and use of primary and hospital care services of people with diabetes according to their risk level by adjusted morbidity groups (AMG) and to analyse the factors associated with the utilisation of these services. METHODS: Cross-sectional study. People with diabetes were identified within the population of patients with chronic conditions of an urban health care centre by the AMG stratification tool integrated into the primary health care electronic clinical record of the Community of Madrid. Sociodemographic, functional, clinical characteristics and annual health care services utilisation variables were collected. Univariate, bivariate and Poisson regression analyses were performed. RESULTS: A total of 1,063 people with diabetes were identified, representing 10.8% of patients with chronic conditions within the health centre. A total of 51.4% were female, the mean age was 70 years, 94.4% had multimorbidity. According to their risk level, 17.8% were high-risk, 40.6% were medium-risk and 41.6% were low-risk. The most prevalent comorbidities were hypertension (70%), dyslipidaemia (67%) and obesity (32.4%). Almost 50% were polymedicated. Regarding health services utilisation, 94% were users of primary care, and 59.3% were users of hospital care. Among the main factors associated with the utilisation of both primary and hospital care services were AMG risk level and complexity index. In primary care, utilisation was also associated with the need for primary caregivers, palliative care and comorbidities such as chronic heart failure and polymedication, while in hospital care, utilisation was also associated with comorbidities such as cancer, chronic obstructive pulmonary disease or depression. CONCLUSIONS: People with diabetes were older, with important needs for care, many associated comorbidities and polypharmacy that increased in parallel with the patient's risk level and complexity. The utilisation of primary and hospital care services was very high, being more frequent in primary care. Health services utilization were principally associated with functional factors related to the need of care and with clinical factors such as AMG medium and high-risk level, more complexity index, some serious comorbidities and polymedication.

An analysis of NHS 111 demand for primary care services: A retrospective cohort study.

The NHS 111 service triages over 16,650,745 calls per year and approximately 48% of callers are triaged to a primary care disposition, such as a telephone appointment with a general practitioner (GP). However, there has been little assessment of the ability of primary care services to meet this demand. If a timely service cannot be provided to patients, it could result in patients calling 999 or attending emergency departments (ED) instead. This study aimed to explore the patient journey for callers who were triaged to a primary care disposition, and the ability of primary care services to meet this demand. We obtained routine, retrospective data from the Connected Yorkshire research database, and identified all 111 calls between the 1st January 2021 and 31st December 2021 for callers registered with a GP in the Bradford or Airedale region of West Yorkshire, who were triaged to a primary care disposition. Subsequent healthcare system access (111, 999, primary and secondary care) in the 72 hours following the index 111 call was identified, and a descriptive analysis of the healthcare trajectory of patients was undertaken. There were 56,102 index 111 calls, and a primary care service was the first interaction in 26,690/56,102 (47.6%) of cases, with 15,470/26,690 (58%) commenced within the specified triage time frame. Calls to 999 were higher in the cohort who had no prior contact with primary care (58% vs 42%) as were ED attendances (58.2% vs 41.8), although the proportion of avoidable ED attendances was similar (10.5% vs 11.8%). Less than half of 111 callers triaged to a primary care disposition make contact with a primary care service, and even when they do, call triage time frames are frequently not met, suggesting that current primary care provision cannot meet the demand from 111.

Validation of the patient reported experiences and outcomes of safety in primary care compact Form Brazil.

OBJECTIVE: To analyze the psychometric properties of the cross-culturally adapted version of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) Compact Form Brazil. METHODS: A methodological study was conducted with 281 adult Primary Health Care users. Data collection took place online. Confirmatory Factor Analysis (CFA) was used to evaluate the psychometric properties of the PREOS-PC after the process of cross-cultural adaptation to the Brazilian context. Internal consistency was evaluated through Cronbach's alpha coefficient (α) and McDonald's omega coefficient (ω). RESULTS: The sample consisted of 73.3% women. The mean age was 36.1 years (SD = 12.2). Of the 23 items of the PREOS-PC that were eligible for CFA, a model with four correlated domains and 16 items presented satisfactory fit indexes. The domains were Practice Activation (PrA) (four items), Patient Activation (PaA) (two items), Experiences of patient safety events (EPaS) (five items) and Outcomes of patient safety (OPaS) (six items). One domain (GPeS) presented one question with a 0 to 10 response scale and two open questions, which cannot be inserted in the CPA due to the nature of the items, but can be included in the application of the scale, being evaluated individually. In this factorial model, five items (EPaS2, EPaS3, EPaS4, EPaS5, EPaS6 and EPaS8) presented factor loadings ≤ 0.30. The α and ω values demonstrated good internal consistency for all domains of the PREOS-PC. CONCLUSIONS: The Brazilian version of the PREOS-PC Compact Form Brazil composed of four domains (PrA, PA, EPaS and OPaS) and 16 items presented evidence of validation of its psychometric properties and can be used to evaluate the experiences and results of patient safety in Primary Health Care in the Brazilian context.

Impact of the COVID-19 pandemic on the self-care and health condition of the older adults. CUIDAMOS+75. A mixed methods study protocol.

Aims: To assess the impact of the COVID-19 pandemic on the health condition of people ≥75 years of age and on their family caregivers in Spain. Design: Multicentric, mixed method concurrent study. Methods: This work, which will be conducted within the primary care setting in 11 administrative regions of Spain, will include three coordinated studies with different methodologies. The first is a population-based cohort study that will use real-life data to analyze the rates and evolution of health needs, care provision, and services utilization before, during, and after the pandemic. The second is a prospective cohort study with 18 months of follow-up that will evaluate the impact of COVID-19 disease on mortality, frailty, functional and cognitive capacity, and quality of life of the participants. Finally, the third will be a qualitative study with a critical social approach to understand and interpret the social, political, and economic dimensions associated with the use of health services during the pandemic. We have followed the SPIRIT Checklist to address trial protocol and related documents. This research is being funded by the Instituto de Salud Carlos III since 2021 and was approved by its ethics committee (June 2022). Discussion: The study findings will reveal the long-term impact of the COVID-19 pandemic on the older adults and their caregivers. This information will serve policymakers to adapt health policies to the needs of this population in situations of maximum stress, such as that produced by the COVID-19 pandemic. Trial Registration: Identifier: NCT05249868 [ClinicalTrials.gov].

Managing COPD exacerbations in primary care.

Chronic obstructive pulmonary disease (COPD) is a common but underdiagnosed lung condition that is frequently managed inappropriately. It impacts poorest communities most, where health inequalities are greatest. New acute symptoms of breathlessness, cough, sputum production and wheeze should prompt clinical suspicion of underlying COPD in someone who is a current or ex-smoker (or has exposure to other risk factors) and be followed by referral for quality-assured spirometry once recovered. Management of COPD exacerbations in primary care includes use of short-acting bronchodilators if mild, and antibiotics and a short course of oral prednisolone if moderate/severe. Hospital at home schemes are safe and effective and should be considered for some patients exacerbating in the community; these are increasingly supported by remote monitoring ('virtual wards'). New or worsening hypoxia is an indication for hospital admission and therefore oxygen saturation monitoring is an important part of exacerbation management; clinicians should be aware of patient safety alerts around use of pulse oximeters. Exacerbations drive poor health status and lung function decline and therefore asking about exacerbation frequency at planned reviews and taking action to reduce these is an important part of long-term COPD care. An exacerbation is an opportunity to ensure that fundamentals of good care are addressed. Patients should be supported to understand and act on exacerbations through a supported self-management plan; prompt treatment is beneficial but should be balanced by careful antibiotic and corticosteroid stewardship. COPD rescue packs on repeat prescription are not recommended.

Comparing performance of primary care clinicians in the interpretation of SPIROmetry with or without Artificial Intelligence Decision support software (SPIRO-AID): a protocol for a randomised controlled trial.

INTRODUCTION: Spirometry is a point-of-care lung function test that helps support the diagnosis and monitoring of chronic lung disease. The quality and interpretation accuracy of spirometry is variable in primary care. This study aims to evaluate whether artificial intelligence (AI) decision support software improves the performance of primary care clinicians in the interpretation of spirometry, against reference standard (expert interpretation). METHODS AND ANALYSIS: A parallel, two-group, statistician-blinded, randomised controlled trial of primary care clinicians in the UK, who refer for, or interpret, spirometry. People with specialist training in respiratory medicine to consultant level were excluded. A minimum target of 228 primary care clinician participants will be randomised with a 1:1 allocation to assess fifty de-identified, real-world patient spirometry sessions through an online platform either with (intervention group) or without (control group) AI decision support software report. Outcomes will cover primary care clinicians' spirometry interpretation performance including measures of technical quality assessment, spirometry pattern recognition and diagnostic prediction, compared with reference standard. Clinicians' self-rated confidence in spirometry interpretation will also be evaluated. The primary outcome is the proportion of the 50 spirometry sessions where the participant's preferred diagnosis matches the reference diagnosis. Unpaired t-tests and analysis of covariance will be used to estimate the difference in primary outcome between intervention and control groups. ETHICS AND DISSEMINATION: This study has been reviewed and given favourable opinion by Health Research Authority Wales (reference: 22/HRA/5023). Results will be submitted for publication in peer-reviewed journals, presented at relevant national and international conferences, disseminated through social media, patient and public routes and directly shared with stakeholders. TRIAL REGISTRATION NUMBER: NCT05933694.