Integrating Care Across Primary Care and School in Low-Income, Urban Settings

2014 ◽  
Author(s):  
Paul M. Robbins ◽  
Jennifer A. Mautone ◽  
Thomas J. Power
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Urban Settings

scholarly journals Digitally-enabled approach to improving primary care in a rural and remote low-resource setting

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Ansell
Keyword(s):  
Primary Care ◽  
Public Sector ◽  
Low Income ◽  
Digital Health ◽  
Health Priorities ◽  
Rural And Remote ◽  
Low Resource Settings ◽  
Digital Platform ◽  
Low Resource ◽  
Out Of Pocket Payments

Abstract Introduction An innovative digitally-supported multi-sectoral solution for supporting end-to-end primary care for rural and remote low-income populations in Western Visayas, Philippines was examined to determine its efficacy in supporting health access. This solution brings together multisectoral stakeholders using a digital platform to coordinate the provision of a virtual primary care system. The solution also supports ordering and delivery of low-cost insurance and medicines, with the aim of reducing out-of-pocket payments and complementing public-sector services. Methods Processes and outputs for a novel data-driven digital health solution were documented and analyzed through a mixed methods approach. Researchers conducted interviews with a range of stakeholders, including program beneficiaries and partners. Quantitative data focusing on the project outputs were also examined. Results Through an integrated digital platform to coordinate inputs from the public sector (Department of Health); private sector (pharmaceutical, insurance, and telecom firms); and community (in the form of a peer-worker network), this model offers an example of an innovative approach to primary health delivery in low-resource settings. These inputs are leveraged and informed by a 'big-data' precision approach, based on detailed epidemiological profiles of community residents. This dataset allows for the evidence-based identification of village-specific health priorities and development of corresponding interventions. This approach has contributed to increased access to medicines; affordability of medicines and health services; and community resilience among the target populations. However, barriers involving a local shortage of health human resources and cumbersome eHealth regulations affect program impact. Conclusions This research provides evidence for the scale-up of a multisectoral digital approach to support the implementation of UHC targets in Philippines. Key messages Implementing digital health solutions in low-resource settings is possible. Changes are needed in Philippines health regulations for digital health to properly support UHC implementation.

scholarly journals Examine the association between key determinants identified by the chronic disease indicator framework and multimorbidity by rural and urban settings

2021 ◽  
Vol 11 ◽  
pp. 263355652110281
Author(s):  
John S. Moin ◽  
Richard H. Glazier ◽  
Kerry Kuluski ◽  
Alex Kiss ◽  
Ross E.G. Upshur
Keyword(s):  
Chronic Disease ◽  
Low Income ◽  
Rural Areas ◽  
Chronic Conditions ◽  
Significant Risk ◽  
Administrative Databases ◽  
Multivariable Logistic Regression Model ◽  
Urban Settings ◽  
Rural And Urban ◽  
Indicator Framework

Background: Multimorbidity, often defined as having two or more chronic conditions is a global phenomenon. This study examined the association between key determinants identified by the chronic disease indicator framework and multimorbidity by rural and urban settings. The prevalence of individual diseases was also investigated by age and sex. Methods: The Canada Community Health Survey and linked health administrative databases were used to examine the association between multimorbidity, sociodemographic, behavioral, and other risk factors in the province of Ontario. A multivariable logistic regression model was used to conduct the main analysis. Results: Analyses were stratified by age (20–64 and 65–95) and area of residence (rural and urban). A total sample of n = 174,938 residents between the ages of 20–95 were examined in the Ontario province, of which 18.2% (n = 31,896) were multimorbid with 2 chronic conditions, and 23.4% (n = 40,883) with 3+ chronic conditions. Females had a higher prevalence of 2 conditions (17.9% versus 14.6%) and 3+ conditions (19.7% vs. 15.6%) relative to males. Out of all examined variables, poor self-perception of health, age, Body Mass Index, and income were most significantly associated with multimorbidity. Smoking was a significant risk factor in urban settings but not rural, while drinking was significant in rural and not urban settings. Income inequality was associated with multimorbidity with greater magnitude in rural areas. Prevalence of multimorbidity and having three or more chronic conditions were highest among low-income populations. Conclusion: Interventions targeting population weight, age/sex specific disease burdens, and additional focus on stable income are encouraged.

Using Touch-Screen Technology to Assess Smoking in a Low-Income Primary Care Clinic: A Pilot Study

2011 ◽  
Vol 46 (14) ◽  
pp. 1750-1754 ◽  
Author(s):  
Philip H. Smith ◽  
Gregory G. Homish ◽  
Christopher Barrick ◽  
Nancy L. Grier
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Low Income ◽  
Primary Care Clinic ◽  
Touch Screen ◽  
Care Clinic

scholarly journals Innovative prototypes for cervical cancer prevention in low-income primary care settings

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Arrivillaga ◽  
P C Bermudez ◽  
J P García-Cifuentes
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Cervical Cancer ◽  
Cancer Prevention ◽  
Design Process ◽  
Low Income ◽  
Subsequent Development ◽  
Cervical Cancer Prevention ◽  
Public Healthcare ◽  
Waiting Room

Abstract Issue In 2018, the mortality due to cervical cancer rose by 6.9 compared to the previous year, with 311.365 deaths in total. By 2030, it is estimated that there will be a 21.3% increase in incidence and 26.7% in mortality. In Colombia, cervical cancer is the second cause of death by cancer in women. Description of the Problem We present the design process of innovative prototypes for cervical cancer prevention in primary care centers located in low-income settings in Cali, Colombia, using the Human-Centered Design (HCD) approach. The practice was developed in collaboration with a public healthcare network comprised of 38 urban and rural centers with women between the ages of 25 and 65 years, healthcare providers of the cancer program, healthcare managers. We conducted five HCD stages: research, need synthesis, ideation and co-design process, prototyping and in-context usability testing. We used observations, open-ended interviews and conversations, multi-stakeholder workshops, focus groups, systematic text condensation analyses and tests in real contexts. Results We designed four prototypes: (1) 'Encanto': An educational manicure service, (2) 'No le des la espalda a la citología': A media-based strategy, (3) An educational wireless queuing device in the waiting room, and (4) Citobot: A cervical cancer early detection device, system, and method. Lessons The tests carried out with each prototype showed their value, limitations and possibilities in terms of subsequent development and validation through public health research or clinical research. We recognize that a longer-term evaluation is required in order to determine whether the prototypes will be used regularly, integrated into cervical cancer screening services and effectively improve access to cytology as a screening test. Key messages HCD is a useful methodology for design-based prevention in the field of cervical cancer. Integration of HCD with public health practice would allow the generation of evidence prior to the formulation of policies and programs as well as optimize existing interventions.

Clinical staff impressions on implementation of a teleophthalmology program to improve diabetic retinopathy surveillance informed by implementation science frameworks (Preprint)

2021 ◽  
Author(s):  
Rajeev S. Ramchandran ◽  
Reza Yousefi-Nooraie ◽  
Porooshat Dadgostar ◽  
Sule Yilmaz ◽  
Jesica Basant ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Care Coordination ◽  
Low Income ◽  
Safety Net ◽  
The United States ◽  
Eye Care ◽  
Continuous Training ◽  
Effective Care ◽  
Store And Forward

BACKGROUND Store and forward camera based evaluation or teleophthalmology is considered an effective way to identify diabetic retinopathy, the leading cause of blindness in the United States, but uptake has been slow. OBJECTIVE Understanding the barriers and facilitators of implementing teleophthalmology programs from those actively adopting, running, and sustaining such programs is important for widespread adoption. METHODS This qualitative study in three urban low-income, largely minority-serving safety-net primary care clinics in Rochester, NY, USA interviewed nurses and doctors on implementing a teleophthalmology program using questions informed by Practical, Robust Implementation and Sustainability Model (PRISM) and Consolidated Framework for Implementation Research (CFIR) frameworks. RESULTS Primary care nurses operationalizing the program in their clinics saw increased work burden and lack of self-efficacy as barriers. Continuous training on the teleophthalmology process for nurses, doctors, and administrative staff through in-service and peer-training by champions/super-users were identified by interviewees as needs. Facilitators included the perceived convenience for the patient and a perceived educational advantage to the program as it gave an opportunity for providers to discuss the importance of eye care with patients. Concerns in making and tracking referrals to ophthalmology due to challenges related to care coordination were highlighted. Financial aspects of the program (e.g. patient coverage and care provider reimbursement) were unclear to many staff, influencing adoption and sustainability. CONCLUSIONS Streamlining of processes and workflows, training and assigning adequate staff, effective care coordination between primary care and eye care to improve follow-ups, and ensuring financial viability can all help streamline the adoption of teleophthalmology.

scholarly journals Integrated management of non-communicable diseases in low-income settings: palliative care, primary care and community health synergies

2018 ◽  
pp. bmjspcare-2018-001579 ◽  
Author(s):  
Daniel Munday ◽  
Vandana Kanth ◽  
Shadrach Khristi ◽  
Liz Grant
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Community Health ◽  
Low Income ◽  
Integrated Management ◽  
Premature Mortality ◽  
Communicable Diseases ◽  
Health Coverage ◽  
Non Communicable Diseases ◽  
Care Community

Palliative care is recognised as a fundamental component of Universal Health Coverage (UHC), which individual countries, led by the United Nations and the WHO, are committed to achieving worldwide by 2030—Sustainable Development Goal (SDG) 3.8. As the incidence of non-communicable diseases (NCD) in low-income and middle-income countries (LMICs) increases, their prevention and control are the central aspects of UHC in these areas. While the main focus is on reducing premature mortality from NCDs (SDG 3.4), palliative care is becoming increasingly important in LMICs, in which 80% of the need is found. This paper discusses the challenges of providing comprehensive NCD management in LMICs, the role of palliative care in addressing the huge and growing burden of serious health-related suffering, and also its scope for leveraging various aspects of primary care NCD management. Drawing on experiences in India and Nepal, and particularly a project on the India–Nepal border in which palliative care, community health and primary care-led NCD management are being integrated, we explore the synergies arising and describe a model where palliative care is integral to the whole spectrum of NCD management, from promotion and prevention, through treatment, rehabilitation and palliation. We believe this model could provide a framework for integrated NCD management more generally in rural India and Nepal and also other LMICs as they work to make NCD management as part of UHC a reality.

scholarly journals Retrospective review of the management of acute infections and the indications for antibiotic prescription in primary care in northern Thailand

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e022250 ◽  
Author(s):  
Rachel C Greer ◽  
Daranee Intralawan ◽  
Mavuto Mukaka ◽  
Prapass Wannapinij ◽  
Nicholas P J Day ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Retrospective Review ◽  
Antibiotic Prescription ◽  
Multivariable Logistic Regression Analysis ◽  
Upper Respiratory Tract ◽  
Acute Tonsillitis ◽  
Northern Thailand ◽  
Acute Infections ◽  
Tract Infections

IntroductionAntibiotic use in low-income and middle-income countries continues to rise despite the knowledge that antibiotic overuse can lead to antimicrobial resistance. There is a paucity of detailed data on the use of antibiotics in primary care in low-resource settings.ObjectiveTo describe the presentation of acute infections and the indications for antibiotic prescription.DesignA 2-year retrospective review of routinely collected data.SettingAll 32 primary care units in one district in northern Thailand.ParticipantsPatients attending primary care with a history of fever, documented temperature, International Statistical Classification of Diseases 10 code for infection or prescribed a systemic antibiotic. Patients attending after the initiation of a study on C-reactive protein testing in four centres were excluded.Outcome measuresThe proportion of patients prescribed an antibiotic and the frequency of clinical presentations.Results762 868 patients attended the health centres, of whom 103 196 met the inclusion criteria, 5966 were excluded resulting in 97 230 attendances consisting of 83 661 illness episodes.46.9% (39 242) of the patients were prescribed an antibiotic during their illness. Indications for antibiotic prescription in the multivariable logistic regression analysis included male sex (adjusted OR (aOR) 1.21 (95% CI 1.16 to 1.28), p<0.001), adults (aOR 1.77 (95% CI 1.57 to 2), p<0.001) and a temperature >37.5°C (aOR 1.24 (95% CI 1.03 to 1.48), p=0.020). 77.9% of the presentations were for respiratory-related problems, of which 98.6% were upper respiratory tract infections. The leading infection diagnoses were common cold (50%), acute pharyngitis (18.9%) and acute tonsillitis (5%) which were prescribed antibiotics in 10.5%, 88.7% and 87.1% of cases, respectively. Amoxicillin was the most commonly prescribed antibiotic.ConclusionsNearly half of the patients received an antibiotic, the majority of whom had a respiratory infection. The results can be used to plan interventions to improve the rational use of antibiotics. Further studies in private facilities, pharmacies and dental clinics are required.

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