To evaluate person-centred home visits as an interprofessional learning (IPL) activity for undergraduate students during clinical placements in primary healthcare.

Interprofessional collaboration is known to improve patient safety, increase job satisfaction, and reduce stress among healthcare professionals. Students should already during their basic training experience interprofessional collaboration.

Students from six different educational programmes and supervisors and adjunct clinical lecturers from different professions participated in the learning activity. The students read a description of the patient history before the visit together with a supervisor. During the home visit, the students were responsible for history-taking and for performing relevant examinations. Afterwards, the students made a joint care plan for the patient. Students, supervisors, and adjunct clinical lecturers discussed the outcomes in a seminar and reflected on each other’s professional roles. The students and the patients answered a questionnaire about the activity, and the supervisors and the adjunct clinical lecturers were interviewed in focus groups.

Thirty interprofessional home visits were conducted, involving 109 students from six different healthcare professions. The students reported that they had gained insights into how different professions could collaborate and an increased understanding of teamwork. All patients were satisfied with the visits and felt that they had been listened to. The interview analysis showed one overarching theme: ‘Interprofessional home visits in primary healthcare were an appreciated and effective pedagogical learning activity with a sustainability dependent on organisational factors’.

The students felt that participation in the activity increased their understanding of collaboration and of other professions’ skills. The supervisors found the home visits to be an appreciated and effective learning activity. The results indicate that this learning activity can be used in primary healthcare settings to promote students’ IPL, but organisational factors need to be considered in order to support sustainability.

To determine the responsiveness of primary care chaplaincy (PCC) to the current variety of presenting symptoms seen in primary care. This was done with a focus on complex and undifferentiated illness.

Current presentations to primary care are often complex, undifferentiated and display risk factors for social isolation and loneliness. These are frequently associated with loss of well-being and spiritual issues. PCC provides holistic care for such patients but its efficacy is unknown in presentations representative of such issues. There is therefore a need to assess the characteristics of those attending PCC. The effectiveness of PCC relative to the type and number of presenting symptoms should also be analysed whilst evaluating impact on GP workload.

This was a retrospective observational study based on routinely collected data. In total, 164 patients attended PCC; 75 were co-prescribed antidepressants (AD) and 89 were not (No-AD). Pre- and post-PCC well-being was assessed by the Warwick–Edinburgh mental well-being score. Presenting issue(s) data were collected on a separate questionnaire. GP appointment utilisation was measured for three months pre- and post-PCC.

Those displaying undifferentiated illness and risk factors for social isolation and loneliness accessed PCC. PCC (No-AD) was associated with a clinically meaningful and statistically significant improvement in well-being in all presenting issues. This effect was maintained in those with multiple presenting issues. PCC was associated with a reduction in GP appointment utilisation in those not co-prescribed AD.

Current health-care delivery requires increasingly proactive and inter-professional work. Therefore, collecting patient information and knowledge management is of paramount importance. General practitioners (GPs) are well placed to lead these evolving models of care delivery. However, it is unclear how they are handling these changes. To gain an insight into this matter, the HIV epidemic was chosen as a test case.

Data were collected and analysed from 13 semi-structured interviews with GPs, working in urban communities in Flanders.

GPs use various types of patient information to estimate patients’ risk of HIV. The way in which sexual health information is collected and registered, depends on the type of information under discussion. General patient information and medical history data are often automatically collected and registered. Proactively collecting sexual health information is uncommon. Moreover, the registration of the latter is not obvious, mostly owing to insufficient space in the electronic medical record (EMR).

GPs seem willing to systematically collect and register sexual health information, in particular about HIV-risk factors. They expressed a need for guidance together with practical adjustments of the EMR to adequately capture and share this information.

Cancer is the second leading cause of death worldwide. Lifestyle choices play an important role in the aetiology of cancer with up to 4 in 10 cases potentially preventable. Interventions delivered by healthcare professionals (HCPs) that incorporate risk information have the potential to promote behaviour change. Our aim was to develop a very brief intervention incorporating cancer risk, which could be implemented within primary care.

Guided by normalisation process theory (NPT), we developed a prototype intervention using literature reviews, consultation with patient and public representatives and pilot work with patients and HCPs. We conducted focus groups and interviews with 65 HCPs involved in delivering prevention activities. Findings were used to refine the intervention before 22 HCPs completed an online usability test and provided further feedback via a questionnaire incorporating a modified version of the NoMAD checklist.

The intervention included a website where individuals could provide information on lifestyle risk factors view their estimated 10-year risk of developing one or more of the five most common preventable cancers and access lifestyle advice incorporating behaviour change techniques. Changes incorporated from feedback from the focus groups and interviews included signposting to local services and websites, simplified wording and labelling of risk information. In the usability testing, all participants felt it would be easy to collect the risk information. Ninety-one percent felt the intervention would enable discussion about cancer risk and believed it had potential to be easily integrated into National Health Service (NHS) Health Checks. However, only 36% agreed it could be delivered within 5 min.

With the use of NPT, we developed a very brief intervention that is acceptable to HCPs in primary care and could be potentially integrated into NHS Health Checks. However, further work is needed to assess its feasibility and potential effectiveness.

Yemen crisis, which has been going on for more than six years, represents one of the most gruesome human plights in the modern history, especially children.

This research aimed to present a comprehensive view of Yemeni children’s studies during the ongoing war period, to come up with a comprehensive base that concerns humanitarians, researchers, decision-makers, and general public at large about the reality of the predicament of Yemeni child.

We searched databases and identified 373 articles, of which 68 were included in this review. Review of literature between 2014 and 2020 is taken from academic sources, multilateral organizations, donors, and governmental and non-governmental organizations. The data are analyzed by date and governorates.

We chose 68 articles and divided them according to the diseases and health conditions as follows: infectious diseases (15 studies), non-infectious diseases (10 studies), blood-related diseases (7 studies), oral and dental problems (12 studies), accidents and injuries (2 studies), health system (16 studies), family and community (6 studies). Moreover, the studies were divided geographically as follows: 7 studies that were almost comprehensive for all governorates; additional studies were conducted for Amanat Al Asimah (21 studies), Taiz (12 studies), Aden and Al Hudaydah (7 studies for each), Dhamar and Ibb (6 studies for each), Abyan and Lahij (2 study for each). As for Al Bayda, Marib, Sana’a, and Socotra, each of them had one study.

Our assessment revealed that the ongoing Yemen crisis is underrated and largely neglected. The studies conducted so far do match the ground reality both in terms of inclusiveness and numbers.

Urinary tract infections (UTIs) are common in general practice, and antibiotic resistance is often seen. Urine cultures are advised by the Dutch national UTI guideline for patients at high risk of UTI complications. Prudent use of antibiotics and taking into account national guidelines and urine culture results are important to combat antibiotic resistance in general practice.

To identify subgroups of UTI patients in which the use of urine cultures and antibiotic prescriptions deviates from the national guidelines.

We investigated associations of several characteristics with urine culture orders in patients with UTI in 2015 from seven Dutch general practices (n=1295). These included subgroups at risk for UTI complications, comorbidities, age and history of UTI recurrence. In addition, we assessed the level of adherence to the guideline for antibiotic prescriptions in subgroups at risks for UTI complications.

Urine cultures were ordered in 17% (n=221) of patients, more frequently in high-risk patients (32%) than in low-risk patients (7%), for UTI complications (OR=6.4; 95% CI 4.6–9.0). In low-risk patients, 91% received antibiotics that were recommended in the guideline. For high-risk patients this percentage ranged widely, and was particularly low in the risk groups with signs of tissue invasion (29–50%). Diagnostic and therapeutic adequacy can still be improved by increasing the adherence to the guideline in UTI patients at high risk for complications. This may contribute to containing antibiotic resistance in UTI by ordering urine cultures and use the results to adjust prescriptions to antibiotic susceptibility of the uropathogen.

The purpose of this project is to describe the use of the Swedish National Diabetes Register (NDR) in clinical practice in a Swedish county and to specifically monitor the diabetes care routines at two separate primary health-care centres (PHCC) with a special focus on older patients.

According to Swedish law, all health-care units have to maintain a system for quality evaluation and improvement. As the NDR holds the most important quality indicators, implementation of the NDR in primary care was carried out by an implementation project in 2002–2005.

Initially, a digital questionnaire about NDR routines was sent to all PHCC. Statistics about hemoglobin adult 1c (HbA1c) and blood pressure (BP) was presented for the diabetes teams at two centres who were also interviewed. The responses became the basis for a focus group interview with both teams together, with data subject to content analysis.

The study showed that reporting to the NDR has become a compulsory routine in primary care. The diabetes nurse specialist was responsible for the practical management of the register and used the NDR for continuous monitoring of the patients. Most centres used the NDR’s statistics for evaluation and analyses annually. The diabetes nurse adapted the visits to the patient’s wishes and general condition. Only in terms of target values for HbA1c and BP did they accept slightly higher values for the older patients. Since the NDR was implemented, the registration rate has remained at 75% and has not increased. The reason given was that patients with diabetes living in nursing homes are checked up by the municipal nurse who does not use the NDR. However, the risk of omitting older patients in the NDR could be considerably decreased if data could be transferred from the electronic patient record.

The aim of this paper is to introduce an operational checklist to serve as a tool for policymakers in the WHO European Region to strengthen primary health care (PHC) services and address the COVID-19 pandemic more effectively and to present the results from piloting the tool in Armenia.

PHC has the potential to play a fundamental role in countries’ responses to COVID-19. However, this potential remains unrealized in many countries. To assist countries, the WHO Regional Office for Europe developed a guidance document – Strengthening the Health Systems Response to COVID-19: Adapting Primary Health Care Services to more Effectively Address COVID-19 – that identifies strategic actions countries can take to strengthen their PHC response to the pandemic. Based on this guidance document, an operational checklist was developed to serve as a tool for policymakers to operationalize the recommended actions.

The operational checklist was developed by transforming key points in the guidance document into questions in order to identify potentially modifiable factors to strengthen PHC in response to COVID-19. The operational checklist was then piloted in Armenia in June 2020 as part of a WHO mission to provide technical advice on strengthening Armenia’s PHC response to COVID-19. Two WHO experts performed semi-structured, face-to-face interviews with nine key informants (both facility managers and clinical staff) in three PHC facilities (two in a rural and one in an urban area). The data collected were analyzed to identify underlying challenges limiting PHC providers’ ability to effectively and efficiently respond to COVID-19 and maintain essential health services.

The paper finds that making adjustments only to health services delivery will be insufficient to address most of the challenges identified by PHC providers in the context of COVID-19 in Armenia. In particular, strategic responses to the pandemic were missed, due, in part, to the absence of COVID-19 management teams at the facility level. Furthermore, the absence of PHC experts in Armenia’s national pandemic response team meant that health system issues identified at the facility level could not easily be communicated to or addressed by policymakers. The checklist therefore helps policymakers identify critical challenges – at both the facility and health system level – that need to be addressed to strengthen the PHC response to the COVID-19 pandemic.

To evaluate the variations in effect of public reporting in antibiotic prescribing practice among physicians with different performance in primary healthcare settings.

Overprovision of antibiotics is a major public health concern. Public reporting has been adopted to encourage good antibiotic prescribing practices. However, which group, for instance, high, average or low antibiotic prescribers, accounted for antibiotic prescription reduction has not been fully understood.

A cluster randomized-controlled trial was conducted. In total, 20 primary healthcare institutions in Qianjiang city were paired through a six indicators-synthesized score. Coin flipping was used to assign control–intervention status; 10 were then subjected to intervention where prescription indicators were publicly reported monthly over a one-year period. Prescriptions for upper respiratory tract infections (URTIs) before and after the intervention were collected. Physicians were divided into high, average and low antibiotic prescribers based on their antibiotic prescribing rates last month, which were publicly reported in intervention arm. Multilevel difference-in-differences logit regressions were performed to estimate intervention effect in each physician group on three outcome indicators: prescriptions containing antibiotics, two or more antibiotics and antibiotic injections.

In total, 31 460 URTI prescriptions were collected (16 170 in intervention arm and 15 290 in control arm). Reduction in antibiotic prescription attributed to intervention was 2.82% [95% confidence intervals (CI): −4.09, −1.54%, P<0.001], least significant in low prescribers (−1.41%, 95% CI: −3.81, 0.99%, P=0.249) and most significant in average prescribers (−5.01%, 95% CI: −6.94, −3.07%, P<0.001). Reduction in combined antibiotics prescriptions attributed to intervention was 3.81% (95% CI: −5.23, −2.39%, P<0.001), least significant in low prescribers (−2.42%, 95% CI: −4.39, −0.45%, P=0.016) and most significant in average prescribers (−5.01%, 95% CI: −7.47, −2.56%, P<0.001).

Public reporting can positively influence antibiotic prescribing patterns of physicians for URTIs in primary care settings, with reduction in antibiotic and combined antibiotic prescriptions. The reduction was mainly attributed to average and high antibiotic prescribers.

Healthcare professionals’ vaccine recommendation is the most effective method to increase vaccination rates of the community. The vaccine counseling and recommendation behavior of pharmacists, who are among the easily accessible healthcare professionals, are influenced by their knowledge and attitudes about vaccines.

It was aimed to investigate community pharmacists’ knowledge, attitudes, and practices regarding commonly used vaccines.

A cross-sectional study was conducted as an online survey with a sample of 1100 community pharmacists in Turkey. Pharmacists were invited to participate in the study by phone calls. A structured survey, which consists of 40 questions to assess the knowledge, attitudes, and practices regarding vaccines, was sent to the e-mail addresses of pharmacists who volunteered to participate in the study.

A total of 430 pharmacists completed the survey. Thirty percent of pharmacists had lack of knowledge about vaccination during pregnancy, whereas 52.2% and 31.4% of pharmacists believed that tetanus and influenza vaccines should be provided during pregnancy, respectively. Nearly 89% of pharmacists recommended vaccines to patients, mainly for influenza vaccine (83.9%). Only 31.5% of pharmacists had been vaccinated against influenza in the last season, whereas 50.5% had never been vaccinated. Pharmacists who had been vaccinated with influenza vaccine had a high rate of recommending influenza vaccines to the patients.

The present study found that vaccination among pharmacists in Turkey and their knowledge on vaccination during pregnancy were low. Further education of pharmacists to improve their knowledge and attitudes toward vaccines is needed.

To explore nurses’ experiences of suicide risk assessment in telephone counselling (TC) in primary health care (PHC).

Globally, priority is given to developing suicide prevention work in PHC. However, suicide risk assessments in TC are not included in these interventions even though these are a common duty of nurses in PHC. More expertise in the field can contribute to knowledge important for developing nurses’ tasks within PHC.

A qualitative interview study was conducted with 15 nurses. Data were analysed using conventional content analysis.

As suicide risk assessment in TC is a common duty for nurses in PHC, they need to be listened to and given the right conditions to perform this work. The nurses lack training in how to carry out suicide risk assessments and are forced to learn through experience. Intuition guides them in their work. A prerequisite for making correct assessments over the telephone is that the nurses are given time as well as the right competence. The PHC organisation needs to create these conditions. Furthermore, interventions to support suicide prevention need to include strategies to help nurses perform suicide assessment in TC.

In Sweden, quality indicators in health care have been the basis for developing National Quality Registers. The Swedish National Diabetes Register (NDR) – one of the largest diabetes registers globally – was introduced in primary health care (PHC) in the county of Östergötland by an implementation project, 2002–2005.

The aim of the present paper was to investigate, by using the results of the NDR, whether the registration led to sustained outcomes of medical results of diabetes care in PHC in the county during the period 2005–2009.

HbA1c, blood pressure (BP), albuminuria and low-density lipoprotein-cholesterol were registered online in the NDR. In 2005 and 2006, goal achievement for HbA1c was measured and compared between PHC centres (PHCC) within the county. In 2007, achievements to national goals were compared between the PHCCs within the county and with those Swedish counties that had attained a sufficiently high registration rate. In 2008 and 2009, the average county results were compared with the corresponding national average measurements for all 21 Swedish counties combined.

In 2005, a clear improvement trend for HbA1c and BP was shown within the county. In 2007–2009, goal achievements in the county studied were slightly better than the other counties measured and the country as a whole in almost every comparison.

The present study has shown association between medical results and registration in the NDR. As the project was primarily a quality improvement work, the results have continuously influenced the development of diabetes care. Both the health professions and the county council now have – in the NDR – an effective and rapid method for evaluation and follow-up of diabetes care. The systematic documentation, followed by comparisons and analyses, create ideas for care improvements.

Screening women for depression and psychosocial risk during the perinatal period is recognised best practice. Screening by current pen and paper methods can be time consuming, and prone to scorer error. The lack of readily available translated versions of screening tools also excludes many women from different cultures.

To evaluate a perinatal mental health digital screening platform, iCOPE. The trial was conducted in a community maternal and child health setting in Melbourne, Australia.

A descriptive, cohort design was used. All women attending the urban clinic were invited to complete their routine perinatal screening on the digital platform, designed to automate score calculations and produce instant clinical and client reports whilst collecting data in real time. Screening included the Edinburgh Postnatal Depression Scale (EPDS) and psychosocial risk questions in line with current national clinical guidelines. Functionality of iCOPE was assessed according to duration of screening, completion rates, accuracy of reporting and level of engagement by women.

During the trial, 144 screens were performed. The mean screening time was 6.7 min (SD=3.78). Most (65.7% n=94) women took between 3 and 6 min. Mean EPDS score was 7.2 with 16% (n=23) scoring 13 or more. The accuracy of reports was 100% and screening completion rate was 99.3%. Many women (81.3%) requested a copy of their personal report.

The iCOPE platform was efficient in terms of screening time, scoring accuracy, and engagement of women. The automated production of tailored client and clinical reports enabled screening outcomes to be instantly communicated to women and health professionals. The collection of data in real time facilitated the monitoring of screening rates and evaluation of outcomes by clinicians and service managers.

The UK Society for Academic Primary Care (SAPC) is re-examining the sustainability of careers in academic primary care (APC). The motivation for this is a number of significant changes within the context of APC since the last such investigation (SAPC, 2003). It is now timely to review the current situation.

As a first phase, semi-structured interviews were undertaken with 15 SAPC members from different disciplines and career stages.

Findings show that lack of clarity about APC career pathways persist, but important factors linked with sustainability were identified at individual and organisational levels. These include being proactive, developing resilience, mentorship and a positive organisational culture with a strong shared vision about why APC is important.

Sustainability is undermined by funding difficulties, lack of integration of members of different APC disciplines, leading to disparities in career progression and lack of clarity about what APC is. Phase 2 will comprise a UK-wide survey.

To determine whether environmental house calls that improved indoor air quality (IAQ) is effective in reducing symptoms of chemical intolerance (CI).

Prevalence of CI is increasing worldwide. Those affected typically report symptoms such as headaches, fatigue, ‘brain fog’, and gastrointestinal problems – common primary care complaints. Substantial evidence suggests that improving IAQ may be helpful in reducing symptoms associated with CI.

Primary care clinic patients were invited to participate in a series of structured environmental house calls (EHCs). To qualify, participants were assessed for CI with the Quick Environmental Exposure and Sensitivity Inventory. Those with CI volunteered to allow the EHC team to visit their homes to collect air samples for volatile organic compounds (VOCs). Initial and post-intervention IAQ sampling was analyzed by an independent lab to determine VOC levels (ng/L). The team discussed indoor air exposures, their health effects, and provided guidance for reducing exposures.

Homes where recommendations were followed showed the greatest improvements in IAQ. The improvements were based upon decreased airborne VOCs associated with reduced use of cleaning chemicals, personal care products, and fragrances, and reduction in the index patients’ symptoms. Symptom improvement generally was not reported among those whose homes showed no VOC improvement.

Improvements in both IAQ and patients’ symptoms occur when families implement an action plan developed and shared with them by a trained EHC team. Indoor air problems simply are not part of most doctors’ differential diagnoses, despite relatively high prevalence rates of CI in primary care clinics. Our three-question screening questionnaire – the BREESI – can help physicians identify which patients should complete the QEESI. After identifying patients with CI, the practitioner can help by counseling them regarding their home exposures to VOCs. The future of clinical medicine could include environmental house calls as standard of practice for susceptible patients.