Primary care healthcare policy impelmentation in the eastern Mediterranean region; experience of six countries: part ii

Background: Primary healthcare (PHC) is the cornerstone of health systems for the rightful access and cost-effective. It is a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of health system under prevailing circumstances essential to implement PHC, but data are unavailable. Objectives: This paper describes and analyses the health systems of Algeria, Kuwait, Morocco, Saudi Arabia, Jordan and Iraq and PHC status. Methods: Data were collected during a Workshop at 2018 WONCA East Mediterranean Regional Conference in Kuwait. Academic family physicians (FP) and general practitioners (GP) presented their country reports using the WONCA framework of 11 PowerPoint slides. WHO EMRO reflected on how countries’ experiences can contribute to their Frameworks on Integrated People-Centered Health Services and UHC.. Results: The six countries had achieved a great improvement in populations’ health, but currently face challenges of health financing, small number of certified family physicians, difficulties to access service and bureaucratic process. Main concerns were the absence of a family practice model, brain drain and immigration of FPs. Countries differed in building a coherent policy. Conclusion: Priorities should be focused on: developing PHC model in Eastern Mediterranean Region with advocacy for community-based PHC to policymakers: capacity building for strengthening PHC-oriented health systems with FP specialty training and restrict practicing to fully trained FPs; engage communities to improve understanding of PHC; adopt quality and accreditation policies for better services; validation of the referral and follow-up process; and, develop public-private partnership mechanisms to enhance PHC for UHC

Patient-initiated second medical consultations: patient characteristics and motivating factors, impact on care and satisfaction: A systematic review

Objectives: To review the characteristics and motivations of patients seeking second opinions, and the impact of such opinions on patient management, satisfaction, and cost-effectiveness. Data sources: Embase, Medline, PsycINFO and HMIC databases. Study design: A systematic literature search was performed for terms related to second opinion and patient characteristics. Study quality was assessed using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data collection / Extraction methods: We included articles focused on patient-initiated second opinions, which provided quantitative data on their impact on diagnosis, treatment, prognosis or patient satisfaction, described the characteristics or motivating factors of patients who initiated a second opinion, or the cost-effectiveness of patient-initiated second opinions. Principal findings: Thirty-one articles were included in the review. 27 studies considered patient characteristics, 18 patient motivating factors, 10 patient satisfaction, and 17 clinical agreement between the first and second opinion. Seeking a second opinion was more common in women, middle age patients, more educated patients; and in people having a chronic condition, with higher income or socioeconomic status or living in central urban areas. Patients seeking a second opinion sought to gain more information or reassurance about their diagnosis or treatment. While many second opinions confirm the original diagnosis or treatment, discrepancies in opinions had a potential major impact on patient outcomes in up to 58% of cases. No studies reporting on the cost-effectiveness of patient initiated second opinions. Conclusions: Seeking a second opinion was more common in women, middle-age patients, and more educated patients, and in people having a chronic condition, with higher income or socioeconomic status or living in central urban areas. Patients seeking a second opinion sought to gain more information or reassurance about their diagnosis or treatment

Support for UNRWA's survival

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides life-saving humanitarian aid for 5·4 million Palestine refugees now entering their eighth decade of statelessness and conflict. About a third of Palestine refugees still live in 58 recognised camps. UNRWA operates 702 schools and 144 health centres, some of which are affected by the ongoing humanitarian disasters in Syria and the Gaza Strip. It has dramatically reduced the prevalence of infectious diseases, mortality, and illiteracy. Its social services include rebuilding infrastructure and homes that have been destroyed by conflict and providing cash assistance and micro-finance loans for Palestinians whose rights are curtailed and who are denied the right of return to their homeland

Unlocking towns and cities: COVID-19 exit strategy

The novel Coronavirus SARS-2 represents a major global challenge since the first cases were diagnosed in China and reported to the World Health Organization (WHO) on 31 December 2019 (1). On 9 January 2020, WHO issued a statement warning of the ‘risk’ of human-to-human transmission, although China did not report such a meth-od of transmission (2). WHO officially declared a Public Health Emergency on 30 January 2020 and the disease was named COVID-19 on 11 February 2020. On 11 March, it was characterized as a pandemic when the number of cases increased 13-fold. At this point, it had spread to over 60 countries across all continents except Antarctica, with an immediate and profound effect on societies and brought social and economic life to a virtual standstill. As of 30 April, 2020, 3 271 892 cases of COVID-19 were report-ed globally with 232 817 deaths (3). More than one-third of the world population was locked down (4), as part of the ‘suppression’ strategy first proposed by Imperial College London, United Kingdom (5). Such a strategy is aimed at reducing the spread of infection, protect health services and save lives. However, it has a major economic impact globally and has had a deep social and psychological im-pact on many people. Therefore, it is not feasible to main-tain the current lockdown indefinitely. This commentary aims to define the public health principles and the meas-ures that must be considered for a science-based political decision to unlock towns and cities

Cardiovascular risk and fruit and vegetable consumption among women in KSA. A cross-sectional study

Objectives This study aims to assess fruit and vegetable consumption among Saudi women to identify perceived benefits and barriers associated with a healthy diet in cardiovascular disease (CVD) risk prevention and to correlate Framingham risk scores (FRSs) with the perceived barriers. Methods A questionnaire adapted from the Health Beliefs Related to Cardiovascular Disease Scale was administered to women attending a primary care centre in KSA. In addition to descriptive statistics, a chi-square test and multiple linear regression analysis were used to determine the association between perceptions of benefit and barriers with FRS categories and between mean FRS and perceived barriers. Results A total of 503 women were included in this study, and 75% of the women were older than 45 years. More than 60% of women were obese, and 97% consumed 1–3 fruit and vegetable servings per day, whereas only 1.4% consumed fruits and vegetables 5 or more times per day. The majority of women were aware of the benefits of a healthy diet in CVD prevention. No significant difference between FRS and perceived benefits or barriers was observed. Barriers across the low- to high-risk groups included a lack of knowledge about a ‘healthy diet’, insufficient time to cook, food affordability, and having more important problems. Women who disagreed on barriers had negative beta coefficients for the mean FRS (p < 0.03). Conclusions In this study cohort, fruit and vegetable intake was lower than the recommended guidelines. Despite awareness of the benefits of a healthy diet in CVD prevention, very few women understood the true meaning of ‘healthy diet’. A direct association between FRS and perceptions/barriers could not be validated. Perceived barriers could be addressed by integrating innovative educational campaigns to existing models of the Healthy Food Plan

Primary care integration of sexual and reproductive health services for chlamydia testing across WHO-Europe: a systematic review

Objective To identify current uptake of chlamydia testing (UCT) as a sexual and reproductive health service (SRHS) integrated in primary care settings of the WHO European region, with the aim to shape policy and quality of care. Design Systematic review for studies published from January 2001 to May 2018 in any European language. Data sources OVID Medline, EMBASE, Maternal and Infant Care and Global Health. Eligibility criteria Published studies, which involved women or men, adolescents or adults, reporting a UCT indicator in a primary care within a WHO European region country. Study designs considered were: randomised control trials (RCTs), quasi-experimental, observational (eg, cohort, case–control, cross-sectional) and mixed-methods studies as well as case reports. Data extraction and synthesis Two independent reviewers screened the sources and validated the selection process. The BRIGGS Critical Appraisal Checklist for Analytical Cross-Sectional Studies, the Mixed Methods Appraisal Tool 2011 and Critical Appraisal Skills Programme (CASP) checklists were considered for quality and risk of bias assessment. Results 24 studies were finally included, of which 15 were cross-sectional, 4 cohort, 2 RCTs, 2 case–control studies and 1 mixed-methods study. A majority of the evidence cites the UK model, followed by the Netherlands, Denmark, Norway and Belgium only. Acceptability if offered test in primary healthcare (PHC) ranged from 55% to 81.4% in women and from 9.5% to 70.6% when both genders were reported together. Men may have a lower UCT compared with women. When both genders were reported together, the lowest acceptability was 9.5% in the Netherlands. Denmark presented the highest percentage of eligible people who tested in a PHC setting (87.3%). Conclusions Different health systems may influence UCT in PHC. The regional use of a common testing rate indicator is suggested to homogenise reporting. There is very little evidence on integration of SRHS such as chlamydia testing in PHC and there are gaps between European countries

Lessons on the COVID-19 pandemic, for and by primary care professionals worldwide

The COVID-19 pandemic has modified organisation and processes of primary care. In this paper, we aim to summarise experiences of international primary care systems. We explored personal accounts and findings in reporting on the early experiences from primary care during the pandemic, through the online Global Forum on Universal Health Coverage and Primary Health Care. During the early stage of the pandemic, primary care continued as the first point of contact to the health system but was poorly informed by policy makers on how to fulfil its role and ill equipped to provide care while protecting staff and patients against further spread of the infection. In many countries, the creativity and initiatives of local health professionals led to the introduction or extension of the use of telephone, e-mail and virtual consulting, and introduced triaging to separate ‘suspected)’ COVID-19 from non-COVID-19 care. There were substantial concerns of collateral damage to the health of the population due to abandoned or postponed routine care. The pandemic presents important lessons to strengthen health systems through better connection between public health, primary care, and secondary care to cope better with future waves of this and other pandemics. KEY MESSAGES It was fairly easy to convince the population to postpone contact with primary care in the first days when practices had to carry out a reorganisation and innovate to the new situation. The bigger problem was encouraging people to resume seeking care as usual as quickly as possible

Small music programs for mental health and well-being: an evaluation framework

There is growing interest in the intersection of music and health, there is a lack of understanding of music’s broader, multifaceted effects on health. Group singing, in particular, has been reported to have benefits on physical, mental, and social health; but interactions between different effects to improve overall health and well-being are not well understood. This paper evaluated group singing programs to develop a three-category framework through organizing raw data to trace interactions amongst various effects of participating in group singing activities. The research population was two programs based in the Royal Borough of Kensington and Chelsea (RBKC), London, UK meant to meet demands for community-serving non-medical interventions: the Sing to Live, Live to Sing in 2016, an adult singing program based in community centers across RBKC, and the (G)uided (L)earning, (U)niting and (E)ducating (GLUE) Sings program, an adolescent music-making and singing program piloted by RBKC’s Tabernacle W11 in 2018. Both programs were found to improve the holistic well-being of participants. The three-category framework was useful in organizing data and showing interactions between effects of singing on health. The framework can be used in future research using mixed methodologies and increasing collaboration amongst funders, researchers, program managers, and policymakers. (PsycInfo Database Record (c) 2021 APA, all rights reserved

Characteristics of frequently attending children in hospital emergency departments: a systematic review

Objective: To summarise the literature on frequent attendances to hospital emergency departments and describe sociodemographic and clinical characteristics of children who attend EDs frequently. Setting: Hospital emergency departments. Participants: Children <21 years, attending hospital emergency departments frequently. Primary outcome measures: Outcomes measures were defined separately in each study, and were predominantly the number of ED attendances per year. Results: We included 21 studies representing 6,513,627 children. Between 0.3% to 75% of all paediatric ED users were frequent users. Most studies defined 4 or more visits per year as a “frequent ED” usage. Children who were frequent ED users were more likely to be less than 5 years old. In the US, patients with public insurance were more likely to be frequent attenders. Frequent ED users more likely to be frequent users of primary care and have long-term conditions; the most common diagnoses were infections and gastroenteritis. Conclusions: The review included a wide range of information across various health systems, however children who were frequent ED users have some universal characteristics in common. Policies to reduce frequent attendance might usefully focus on preschool children and supporting primary care in responding to primary-care oriented conditions