Research gaps in the organisation of primary healthcare in low-income and middle-income countries and ways to address them: a mixed-methods approach

Introduction Since the Alma-Ata Declaration 40 years ago, primary healthcare (PHC) has made great advances, but there is insufficient research on models of care and outcomes—particularly for low-income and middle-income countries (LMICs). Systematic efforts to identify these gaps and develop evidence-based strategies for improvement in LMICs has been lacking. We report on a global effort to identify and prioritise the knowledge needs of PHC practitioners and researchers in LMICs about PHC organisation. Methods Three-round modified Delphi using web-based surveys. PHC practitioners and academics and policy-makers from LMICs sampled from global networks. First round (pre-Delphi survey) collated possible research questions to address knowledge gaps about organisation. Responses were independently coded, collapsed and synthesised. Round 2 (Delphi round 1) invited panellists to rate importance of each question. In round 3 (Delphi round 2), panellists ranked questions into final order of importance. Literature review conducted on 36 questions and gap map generated. Results Diverse range of practitioners and academics in LMICs from all global regions generated 744 questions for PHC organisation. In round 2, 36 synthesised questions on organisation were rated. In round 3, the top 16 questions were ranked to yield four prioritised questions in each area. Literature reviews confirmed gap in evidence on prioritised questions in LMICs. Conclusion In line with the 2018 Astana Declaration, this mixed-methods study has produced a unique list of essential gaps in our knowledge of how best to organise PHC, priority-ordered by LMIC expert informants capable of shaping their mitigation. Research teams in LMIC have developed implementation plans to answer the top four ranked research questions

Clinical Registries Could Improve Influenza Like Illness and COVID-19 Surveillance

Capacity for tracking COVID-19 prevalence patterns is hampered by insufficient data, particularly from rural and small communities. The PRIME Registry holds data for 5.4 million patients in 47 states who made 638,983 Influenza-Like Illness (ILI) visits in 2019, mirroring CDC’s ILINet temporal patterns but with higher volume and greater rural penetration. Clinical data registries are viable partners that could fill gaps for epidemic sentinel functions and have rich patient data which may identify factors predictive of COVID-19 morbidity and mortality.https://deepblue.lib.umich.edu/bitstream/2027.42/154853/1/ILI-PRIME_AnnalsFamMed_FINAL.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154853/2/RehkopfILIFig1.docxhttps://deepblue.lib.umich.edu/bitstream/2027.42/154853/3/RehkopfILIFig2.docxDescription of ILI-PRIME_AnnalsFamMed_FINAL.pdf : Main ArticleDescription of RehkopfILIFig1.docx : Figure 1Description of RehkopfILIFig2.docx : Figure

Mobility of US rural primary care physicians during 2000-2014

PURPOSE Despite considerable investment in increasing the number of primary care physicians in rural shortage areas, little is known about their movement rates and factors influencing their mobility. We aimed to characterize geographic mobility among rural primary care physicians, and to identify location and individual factors that influence such mobility. METHODS Using data from the American Medical Association Physician Mas-terfile for each clinically active US physician, we created seven 2-year (biennial) mobility periods during 2000-2014. These periods were merged with county-level “rurality,” physician supply, economic characteristics, key demographic measures, and individual physician characteristics. We computed (1) mobility rates of physicians by rurality; (2) linear regression models of county-level rural nonreten-tion (departure); and (3) logit models of physicians leaving rural practice. RESULTS Biennial turnover was about 17% among physicians aged 45 and younger, compared with 9% among physicians aged 46 to 65, with little difference between rural and metropolitan groups. County-level physician mobility was higher for counties that lacked a hospital (absolute increase = 5.7%), had a smaller population size, and had lower primary care physician supply, but area-level economic and demographic factors had little impact. Female physicians (odds ratios = 1.24 and 1.46 for those aged 45 or younger and those aged 46 to 65, respectively) and physicians born in a metropolitan area (odds ratios = 1.75 and 1.56 for those aged 45 or younger and those aged 46 to 65, respectively) were more likely to leave rural practice. CONCLUSIONS These findings provide national-level evidence of rural physician mobility rates and factors associated with both county-level retention and indi-vidual-level departures. Outcomes were notably poorer in the most remote locations and those already having poorer physician supply and professional support. Rural health workforce planners and policymakers must be cognizant of these key factors to more effectively target retention policies and to take into account the additional support needed by these more vulnerable communities

Comparison Between US Preventive Services Task Force Recommendations and Medicare Coverage

PURPOSE The US Preventives Services Task Force (USPSTF) is authorized by the US government to review and disseminate the scientific evidence for clinical preventive services. The purpose of this study was to evaluate the alignment of Medicare preventive services coverage with the recommendations of the USPSTF before implementation of health reform

Status of Underrepresented Minority and Female Faculty at Medical Schools Located within Historically Black Colleges and in Puerto Rico.

Background and objectives: To assess the impact of medical school location in Historically Black Colleges and Universities (HBCU) and Puerto Rico (PR) on the proportion of underrepresented minorities in medicine (URMM) and women hired in faculty and leadership positions at academic medical institutions. Method: AAMC 2013 faculty roster data for allopathic medical schools were used to compare the racial/ethnic and gender composition of faculty and chair positions at medical schools located within HBCU and PR to that of other medical schools in the United States. Data were compared using independent sample t-tests. Results: Women were more highly represented in HBCU faculty (mean HBCU 43.5% vs. non-HBCU 36.5%, p=0.024) and chair (mean HBCU 30.1% vs. non-HBCU 15.6%, p=0.005) positions and in PR chair positions (mean PR 38.23% vs. non-PR 15.38%, p=0.016) compared with other allopathic institutions. HBCU were associated with increased African American representation in faculty (mean HBCU 59.5% vs. non-HBCU 2.6%, p=0.011) and chair (mean HBCU 73.1% vs. non-HBCU 2.2%, p≤0.001) positions. PR designation was associated with increased faculty (mean PR 75.40% vs. non-PR 3.72%, p≤0.001) and chair (mean PR 75.00% vs. non-PR 3.54%, p≤0.001) positions filled by Latinos/Hispanics. Conclusions: Women and African Americans are better represented in faculty and leadership positions at HBCU, and women and Latino/Hispanics at PR medical schools, than they are at allopathic peer institutions