Mother's health card: A simple technology for use in primary health care

The incidence of low birth weight in Indonesia as well as other developing countries is high. This can be reduced, if at risk pregnant women can be identified and their risks lowered. A 2-year cohort prospective study of 1,281 pregnant women found that maternal nutrition, including height and weight during pregnancy affected the birth weight of infants. On the basis of these findings, a Mother's Health Card was developed to monitor maternal weight during pregnancy and to observe factors affecting low birth weight. The validation study of the use of this card in four different ethnic and geographic areas found that the prediction values for identifying women who were at risk of delivering low birth weight infants was adequately high. The card proved simple, usable by village cadres, action oriented, and facilitated health nutrition education as well as persuading women to use available health care services. It also promoted better maternal and foetal nutrition by increasing the level of awareness of the women, the cadres, and the health personnel.     

The origins of primary health care and selective primary health care

I present a historical study of the role played by the World Health Organization and UNICEF in the emergence and diffusion of the concept of primary health care during the late 1970s and early 1980s. I have analyzed these organizations' political context, their leaders, the methodologies and technologies associated with the primary health care perspective, and the debates on the meaning of primary health care. These debates led to the development of an alternative, more restricted approach, known as selective primary health care. My study examined library and archival sources; I cite examples from Latin America.     

Socioeconomic position,health, and possible explanations: a tale of two cohorts

OBJECTIVES: We examined whether the social gradient for measures of morbidity is comparable in English and French public employees and investigated risk factors that may explain this gradient. METHODS: This longitudinal study of 2 occupational cohorts-5825 London civil servants and 6818 French office-based employees-used 2 health outcomes: long spells of sickness absence during a 4-year follow-up and self-reported health. RESULTS: Strong social gradients in health were observed in both cohorts. Health behaviors showed different relations with socioeconomic position in the 2 samples. Psychosocial work characteristics showed strong gradients in both cohorts. Cohort-specific significant risk factors explained between 12% and 56% of the gradient in sickness absence and self-reported health. CONCLUSIONS: Our cross-cultural comparison suggests that some common susceptibility may underlie the social gradient in health and disease, which explains why inequalities occur in cultures with different patterns of morbidity and mortality.     

Attitudes to and management of fertility among primary health care physicians in Turkey: An epidemiological study

Background  

The subject of infertility has taken its place in the health sector at the top level. Since primary health care services are insufficient, most people, especially women, keep on suffering from it all over the world, namely in underdeveloped or developing countries.     

Prevalence of chronic diseases and morbidity in primary health care in central Greece: An epidemiological study

Background  

In Greece there is lack of large epidemiological studies regarding morbidity and mortality in primary health care. The aim of the present study was to estimate the prevalence and morbidity of the most common diseases in a large population sample from primary health care.     

Towards equivalent health care of prisoners: European soft law and public health policy in Geneva

Prisoners have a right to health care and to be protected against inhumane and degrading treatment. Health care personnel and public policy makers play a central role in the protection of these rights and in the pursuit of public health goals. This article examines the legal framework for prison medicine in the canton of Geneva, Switzerland and provides examples of this framework that has shaped prisoners' medical care, including preventive measures. Geneva constitutes an intriguing example of how the Council of Europe standards concerning prison medicine have acquired a legal role in a Swiss canton. Learning how these factors have influenced implementation of prison medicine standards in Geneva may be helpful to public health managers elsewhere and encourage the use of similar strategies.     

Disease prevalence and use of health care among a national sample of black and white male state prisoners

U.S. prisons have a court-affirmed mandate to provide health care to prisoners. Given this mandate, we sought to determine whether use of prison health care was equitable across race using a nationally-representative sample of Black and White male state prisoners. We first examined the prevalence of health conditions by race. Then, across all health conditions and for each of 15 conditions, we compared the proportion of Black and White male prisoners with the condition who received health care. For most conditions including cancer, heart disease, and liver-related disorders, the age-adjusted prevalence of disease among Blacks was lower than among Whites (p<.05). Blacks were also modestly more likely than Whites to use health care for existing conditions (p<.05), particularly hypertension, cerebral vascular accident/brain injury, cirrhosis, flu-like illness, and injury. The observed racial disparities in health and health care use are different from those among non-incarcerated populations.     

Holistic primary health care for Aboriginal and Torres Strait Islander prisoners: exploring the role of Aboriginal Community Controlled Health Organisations

Objective : Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHOs) have been identified as having an important role in improving the health and wellbeing of individuals in prison; however, a lack of information exists on how to strengthen this role. This paper explores the experiences of ACCHO staff in primary health care to individuals inside or leaving prison. Methods : Nineteen staff from four ACCHOs were interviewed. ACCHO selection was informed by proximity to prisons, town size and/or Local Government Area offending rates. Thematic analysis of the interviews was undertaken. Results : While most ACCHOs had delivered post‐release programs, primary health care delivery to prisoners was limited. Three themes emerged: i) a lack of access to prisoners; ii) limited funding to provide services to prisoners; and iii) the need for a team approach to primary health care delivery. Conclusion : A holistic model of care underpinned by a reliable funding model (including access to certain Medicare items) and consistent access to prisoners could strengthen ACCHOs’ role in primary health care delivery to people inside or leaving prison. Implications for public health : ACCHOs have an important role to play in the delivery of primary health care to prisoners. Existing models of care for prisoners should be examined to explore how this can occur.     

Typical electronic health record use in primary care practices and the quality of diabetes care

PURPOSE

Recent efforts to encourage meaningful use of electronic health records (EHRs) assume that widespread adoption will improve the quality of ambulatory care, especially for complex clinical conditions such as diabetes. Cross-sectional studies of typical uses of commercially available ambulatory EHRs provide conflicting evidence for an association between EHR use and improved care, and effects of longer-term EHR use in community-based primary care settings on the quality of care are not well understood.

METHODS

We analyzed data from 16 EHR-using and 26 non–EHR-using practices in 2 northeastern states participating in a group-randomized quality improvement trial. Measures of care were assessed for 798 patients with diabetes. We used hierarchical linear models to examine the relationship between EHR use and adherence to evidence-based diabetes care guidelines, and hierarchical logistic models to compare rates of improvement over 3 years.

RESULTS

EHR use was not associated with better adherence to care guidelines or a more rapid improvement in adherence. In fact, patients in practices that did not use an EHR were more likely than those in practices that used an EHR to meet all of 3 intermediate outcomes targets for hemoglobin A_1c, low-density lipoprotein cholesterol, and blood pressure at the 2-year follow-up (odds ratio = 1.67; 95% CI, 1.12–2.51). Although the quality of care improved across all practices, rates of improvement did not differ between the 2 groups.

CONCLUSIONS

Consistent use of an EHR over 3 years does not ensure successful use for improving the quality of diabetes care. Ongoing efforts to encourage adoption and meaningful use of EHRs in primary care should focus on ensuring that use succeeds in improving care. These efforts will need to include provision of assistance to longer-term EHR users.     

A challenge for primary health care: mental health care implementation

The objective of this study was to evaluate mental health care provided within a primary health care setting. The study was conducted in a Primary Health Care Center (PHC) in the city of Sao Paulo, Brazil. A comparative study was made between pediatricians' diagnosis of mental health problems and those identified by the Child Behavior Checklist (CBCL) in children (5-11 years) from August to October 2000. Eleven pediatricians were interviewed for more in-depth analysis. The study analyzed 411 patient charts and held 206 interviews with the children's parents. Analysis of the resulting data shows that the pediatricians provided a diagnosis of mental health problems in 17.5% of the children examined. When compared with probable mental health problems identified by the CBCL, only 25.3% of the children were diagnosed by the physician as having mental health problems. Interviews with pediatricians identified difficulties in the definition and conceptualization of mental health problems, lack of organization in the referral system, and insufficient technical support.     

Adolescents with co-occurring mental health and substance use disorders in primary care

Co-occurring mental and substance use disorders (COD) among children and adolescents present special challenges for family members and primary care clinicians. A broad understanding of prevalence rates, etiology, risk and protective factors, and intervention strategies is important in promoting evidence-based practices. The authors present a synopsis of important issues in this area and provide support for integrating behavioral health into primary care practice.     

Immigrants' use of emergency primary health care in Norway: a registry-based observational study

ABSTRACT: BACKGROUND: Emigrants are often a selected sample and in good health, but migration can have deleterious effects on health. Many immigrant groups report poor health and increased use of health services, and it is often claimed that they tend to use emergency primary health care (EPHC) services for non-urgent purposes. The aim of the present study was to analyse immigrants use of EPHC, and to analyse variations according to country of origin, reason for immigration, and length of stay in Norway. METHODS: We conducted a registry based study of all immigrants to Norway, and a subsample of immigrants from Poland, Germany, Iraq and Somalia, and compared them with native Norwegians. The material comprised all electronic compensation claims for EPHC in Norway during 2008. We calculated total contact rates, contact rates for selected diagnostic groups and for services given during consultations. Adjustments for a series of sociodemographic and socio-economic variables were done by multiple logistic regression analyses. RESULTS: Immigrants as a whole had a lower contact rate than native Norwegians (23.7% versus 27.4%). Total contact rates for Polish and German immigrants (mostly work immigrants) were 11.9% and 7.0%, but for Somalis and Iraqis (mostly asylum seekers) 31.8% and 33.6%. Half of all contacts for Somalis and Iraqis were for non-specific pain, and they had relatively more of their contacts during night than other groups. Immigrants rates of psychiatric diagnoses were low, but increased with length of stay in Norway. Work immigrants suffered less from respiratory and gastrointestinal infections, but had more injuries and higher need for sickness certification. All immigrant groups, except Germans, were more often given a sickness certificate than native Norwegians. Use of interpreter was reduced with increasing length of stay. All immigrant groups had an increased need for long consultations, while laboratory tests were most often used for Somalis and Iraqis. CONCLUSIONS: Immigrants use EPHC services less than native Norwegians, but there are large variations among immigrant groups. Work immigrants from Germany and Poland use EPHC considerably less, while asylum seekers from Somalia and Iraq use these services more than native Norwegians.     

Neighborhood variations in the use of city-supported primary health care services by an elderly population

The purpose of this paper is to examine the elderly's use of city-supported primary health care services. The provision of free or low cost health care to the elderly population is a major health policy issue, especially as the size of the elderly population increases and there is a concomitant increase in the need for health services and increases in the out-of-pocket cost of health care.The data analyzed here are based on client records for approximately 6,000 persons 65 and older who utilized the City of Philadelphia's Family Medical Care Program in 1982. Demographic and socioeconomic characteristics, diagnoses and types of services used are examined for all clients citywide and by neighborhood.Elderly clients of the city primary care system tended to be 65–74, female and black. Most clients had low incomes, with about 75–87% having incomes below $6,000. The problems for which care is sought involve long-term, ongoing care.The data show that the elderly are underrepresented in the city-supported primary care system relative to their numbers in the general population. Our findings on diagnosis and services utilization characteristics of those elderly whodo use city-supported primary health care services indicate that the elderly are likely to place demands on the existing system for a substantial amount of resources. The demands for such services are likely to increase especially as the size of the elderly population increases.Lynne Kotranski, Ph.D. is Director of the Division of Research and Evaluation at Philadelphia Health Management Corporation (PHMC). Jay Bolick, M.A. was Senior Programmer at PHMC. Joan Halbert, M.A. is a Research Associate in the Division of Research and Evaluation. Requests for reprints should be addressed to Lynne Kotranski, Ph.D., Philadelphia Health Management Corporation, 841 Chestnut Street, Philadelphia, PA 19107.Data for this paper were collected as part of the larger Neighborhood-Oriented Health Care Data Base Project. The latter was supported by a grant from The Pew Memorial Trust and the William Penn Foundation. The Philadelphia Corporation on Aging provided additional funding for the data analysis presented here. A version of this paper was presented at the Annual Meeting of the Gerontological Society of America. San Antonio, Texas, 1984.