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Mental disorders lead to difficulties in social, occupational and marital relations. Failure to detect mental disorder denies patients potentially effective treatment. This study aimed to assess the prevalence and nature of mental disorders at the primary care settings and the recognition of these disorders by the attending physicians. Over a period of eight weeks, consecutive and consenting patients who attended three randomly selected primary health care facilities in Sagamu Local Government Area of Ogun state were recruited and administered a questionnaire that included a socio-demographic section and Patient Health Questionnaire (PHQ). A total of 412 subjects took part in the study. Subject age ranged from 18-90 years with a mean age of 52.50±21.08 years. One hundred and seventy-six (42.7%) of the subjects were males. A total of 120 (29.1%) of the subjects had depressive disorder, 100 (24.3%) had anxiety disorder, 196 (47.6%) somatoform disorder and 104 (25.2%) met the criteria for an alcohol related problem. The PHC physicians were only able to diagnose disorders relating to mental health in 52 (12.6%) of the subjects. Health and work situations accounted for more than three-quarters of the causes of stress experienced by the subjects. We conclude that there is a high prevalence of mental disorders among patients seen in primary care settings and that a significant proportion of them are not recognized by the primary care physicians. Stress relating to health, work and financial problems is common among primary health care attendees. Physicians in primary health care should be alert to the possibility and the impact of undetected psychiatric morbidity.

This study is a part of the doctoral dissertation that proposes concrete measures to improve health-care information outreach program for rural health-care professionals in primary and secondary health care in Punjab, Pakistan. This study aims to report on the barriers to accessing and using online health-care information from rural settings of the Punjab province of Pakistan.

A cross-sectional survey was conducted in primary and secondary health-care settings in the Punjab province of Pakistan. The study’s population consisted of the rural primary care physicians (PCPs), who were geographically dispersed across 2,873 different remote health-care settings across Punjab. These practice settings included 2,455 basic health units, 293 rural health centers, 89 tehsil headquarter hospitals and 36 district headquarter hospitals.

Limited internet access, non-availability of required equipment and lack of training facilities were identified as the main barriers. PCPs’ gender, previous enrollment in post-graduation programs and type of health-care facility were significant factors in the perceived barriers related to both “non-availability of required equipment” and “inadequate training facilities on the use of information resources”.

The findings of the study hold some important practical implications for different stakeholders. This study identifies and addresses the barriers to accessing and using health-care information for PCPs in rural settings. The success of the health-care information outreach program in Punjab, Pakistan, should rely on the eradication of these barriers.

To the best of the authors’ knowledge, this is the first large-scale study in Pakistan that assesses the barriers and proposes ways to overcome these barriers to effectively access and use health-care information.

This paper aims to explore the value that care from a primary mental health care nurse (PMHCN) can bring to people with mental health (MH) problems in health-care delivery.

This study used a focus group of 20 PMHCNs working in primary care (PC) health settings in Saudi Arabia before using thematic content analysis to describe and explore their views and experiences of the integration of MH care into PC units. The researchers used a semi-structured interview format, which began with open-ended probes and proceeded to use of theoretical sampling based on emerging data related to their experiences and perceptions in the integration process.

Four main themes were derived from the thematic analysis of interviews: collaboration, knowledge and experience, awareness and orientation care and influential role.

This study’s use of qualitative research methods has certain limitations, including the small sample size of 20 participants, which means that it may not be representative of all primary MH nurses in primary health-care centers in Saudi Arabia. To make the results applicable to a broader audience, the researcher sought to moderate this limitation by including participants with extensive experience in multiple settings and nurses of different ages.

The cost implications of the PMHCN service are not yet comprehensively understood, but it is apparent that this model is not only regarded extremely positively by MH practitioners but may also have significant benefits in terms of patient outcomes. The configuration of local services and relevant patient demographics will affect the extent to which this study’s findings are transferable. Meanwhile, further research in this area could seek to provide further evidence about the aspects of the PMHCN service model, such as secondary care referrals and waiting times, accident and emergency attendances and patient recovery rates and the impact of providing such a service on health-care practitioners as well as its cost-effectiveness.

This study’s findings suggest that PMHCNs believe that their care improves the quality of PC for patients in PC settings. Elements of the PC placement that professionals particularly valued include their ability to assist patients in their own community and the inclusion of volunteer stakeholders who act as preceptors. The participants expressed a need for improvement of policy related to referrals within the clinics.

Common mental disorders are not only highly prevalent in primary health-care settings but also negatively affect patients’ quality of life (QoL). This study aims to assess the levels of QoL among patients with common mental disorders seeking care from a monk healer or primary care setting and to determine the comparative QoL of users in two different types of care settings in Thailand.

Consecutively attending clients or patients (N = 1251) of three faith healing or three health centres were assessed with measures of depression, anxiety and somatization disorder and QoL.

The overall QoL was 67.8 and among the four QoL domains, social QoL was the highest (72.3), followed by physical QoL (69.4), environmental QoL (64.8) and psychological QoL (64.6). In adjusted linear regression analyses, sociodemographic factors, such as higher educational level, being employed, having high debt and consulting a health centre, were associated with higher overall QoL. Compared to being a client with a monk healer, patients at a health centre had a higher overall QoL, environmental and psychological QoL. Having a general anxiety or major depressive disorder was negatively associated with overall QoL and all four QoL sub-domains, whereas somatization disorder was not associated with any QoL sub-domains.

To the best of the authors’ knowledge, this is the first study to investigate QoL in common mental disorder attenders with a monk healer in comparison with primary care patients. Primary care patients with a common mental disorder had significantly higher overall QoL (p<0.01), higher psychological QoL (p<0.001) and higher environmental QoL (p<0.001) than clients with a common mental disorder attending monk healers. This study extends previous research showing a negative association between anxiety and depressive disorders and QoL calling for integration of QoL in the management of common mental disorders in both complementary and public primary care in Thailand.

Continuous quality improvement (CQI) programmes have been taken up widely by indigenous primary health care services in Australia, but as yet there has not been a systematic assessment of their focus and achievements. A scoping review of the literature from studies of CQI in indigenous primary health care services was undertaken to explore impacts on service systems, care and client outcomes with the aim of providing guidance on future evaluation efforts. The paper aims to discuss these issues,

Searches were conducted in MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews to December 2016 and handsearching of key websites and publications. Studies of CQI programs or activities in Indigenous primary health care services which demonstrated some combination of CQI characteristics, as described by Rubenstein (2013) were included. A two-stage approach to analysis was undertaken. Stage 1 identified the range and scope of literature, and Stage 2 investigated impacts to service systems, care and client outcomes. The Framework for Performance Assessment in Primary Health Care was used to frame the Stage 2 analysis.

The majority of Aboriginal community controlled health services have been involved in CQI but there are gaps in knowledge about uptake in general practice and government clinics. There are as many baseline studies as studies on impacts over time. Of the 14 studies included for further analysis, 6 reported on impacts on service systems; all 14 reported on impacts on care and 6 on client outcomes. Changes to services systems are variable and studies of impacts on care and client outcomes show promising though uneven improvements. There are no economic studies or studies addressing community engagement in CQI activities.

To supplement existing limited knowledge about which service system change strategies are effective and sustainable for which problems in which settings, there needs to be investment in research and development. Research needs to be grounded in the realities of service delivery and contribute to the development of CQI capacity at the service level. Knowledge translation needs to be built into implementation to ensure maximum benefit to those endeavouring on a daily basis to constantly reflect on and improve the quality of the care they deliver to clients, and to the stewardship structures supporting services at regional, state/territory and national levels.

Improved approaches, methods, data capture and reporting arrangements are needed to enhance existing activity and to ensure maximum benefit to services endeavouring to reflect on and improve quality of care and to the stewardship structure supporting services at regional, state/territory and national levels.

Although there is a growing body of research evidence about CQI both nationally and internationally, and considerable investment by the federal government in Australia to support CQI as part of routine practice, there has not been a systematic assessment of the achievements of CQI in Indigenous primary health care services. Many unanswered questions remain about the extent of uptake, implementation and impacts. This is a barrier to future investment and regional and local programme design, monitoring and evaluation. The authors conducted a scoping review to address these questions. From this, the authors draw conclusions about the state of knowledge in Australia with a view to informing how future CQI research and evaluation might be intensified.

Background – Studies suggest text messaging is beneficial to health care; however, no one has synthesized the overall evidence on texting interventions. In response to this need, we conducted a systematic review of the impacts of text messaging in health care.

Methods – PubMed database searches and subsequent reference list reviews sought English-language, peer-reviewed studies involving text messaging in health care. Commentaries, conference proceedings, and feasibilities studies were excluded. Data was extracted using an article coding sheet and input into a database for analysis.

Results – Of the 61 papers reviewed, 50 articles (82%) found text messaging had a positive effect on the primary outcome. Average sample sizes in articles reporting positive findings (n=813) were significantly larger than those that did not find a positive impact (n=178) on outcomes (p=0.032). Articles were categorized into focal groups as follows: 27 articles (44.3%) investigated the impact of texting on disease management, 24 articles (39.3%) focused texting's impact to public health related outcomes, and 10 articles (16.4%) examined texting and its influence on administrative processes. Articles in focal groups differed by the purpose of the study, direction of the communication, and where they were published, but not in likelihood of reporting a positive impact from texting.

Conclusions – Current evidence indicates that text messaging health care interventions are largely beneficial clinically, in public health related uses, and in terms of administrative processes. However, despite the promise of these findings, literature gaps exist, especially in primary care settings, across geographic regions and with vulnerable populations.

National Health and Morbidity Survey of Malaysia 2011 revealed that hypercholesterolemia (35.1 per cent, 6.2 million) was the primary leading causes of cardiovascular disease in Malaysia. Currently, three established recommended approaches such as therapeutic lifestyle change (TLC) diet, pharmacotherapy (simvastatin) and TLC + simvastatin are available to the public but, to our knowledge, have never been compared in Malaysia Primary Health Care setting. Hence, this paper aims to compare the lipid lowering effects of these three approaches in a primary health care clinic.

This randomized trial enrolled 180 patients with hypercholesterolemia who met adult treatment panel III (ATP III) criteria. All participants were randomized to TLC diet, simvastatin (10-20 mg/d) or TLC + simvastatin diets. The TLC group was enrolled in a 12-week multidisciplinary lifestyle program that involved monthly 45 minutes to hour meetings. The simvastatin group received medication, and traditional counseling was conducted by registered medical officer. Another group was enrolled into TLC + simvastain treatment. The primary outcome measure was the percentage change in low-density lipoprotein-cholesterol. Secondary measures were changes in weight loss, blood pressure and dietary changes. Assessments were repeated at three-month interval.

Lifestyle changes combined with simvastatin had a better lipid lowering effect compared to the other two treatments. However, TLC had a better weight and blood pressure reduction compared to the other two treatments. Nevertheless, TLC group showed reduction proportions similar to standard therapy with simvastatin or TLC + simvastatin. TLC has proven as an alternative approach to hyperlipidemia for a subset of patients unwilling or unable to take statins especially in a community-based, primary health care setting.

Weight loss was not recorded for simvastatin participants, and this was the major drawback of this study, and there was no comparable weight loss reduction with other groups.

In Malaysia, the efficacy of hypocholesterolemic therapies among patients who are receiving the most common lipid-lowering drug, simvastatin, in primary health care setting has not been clearly defined. There is also a lack of research on the efficacy of TLC conducted by registered dietitian in a primary health care setting in Malaysia.

Service quality is an elusive and abstract construct, so that particular effort is required to establish a valid measure. Patients' perceptions of health services seem to have been largely ignored by health care providers. The purpose of this paper is to propose a modified approach to the measurement of service quality in a primary health care setting.

Through the use of the HEALTHQUAL scale adapted from the SERVQUAL scale to the context of primary health care centres, the authors measure the perceptions of service quality reported by both users and health centre managers in Spain. Taking service quality to be a construct of a formative nature, the authors propose a modification for its measurement using partial least squares (PLS) path modelling, as recommended in the literature for the modeling of formative constructs.

It is found that the model provides health centre managers with a tool for the measurement of functional quality in their organization. The results reveal the importance of health staff attributes and efficiency measures for the perception of health centre quality.

The model can also be used to measure how health care centre managers believe that patients perceive the quality of their service. This allows the potential gap between the provider's view and the customer's view to be assessed and monitored.

The paper extends the previous literature in two directions. First, based on SERVQUAL, it presents a general framework for measuring primary health care service quality as a construct of a formative nature. Second, it is the first application of PLS path modeling to the simultaneous examination of both users' and health centre managers' perceptions in a European context.

Research on mental illness stigma in the Arab world has traditionally focused on socio-cultural barriers that deprive persons with mental illness from their fundamental human right for privacy and informed consent. The purpose of this paper is to address the question whether or not mental health legislations in a number of Arab countries effectively safeguard the human rights of people with mental illness and protect them from stigmatizing and discriminatory practices.

A qualitative review of literature was performed over two rounds of search, targeting published research on mental illness stigma in the Arab world from year 2000 until now and existing national mental health legislations in the Arab world, using English and Arabic databases.

The review reveals that beyond society and culture, persistence of mental illness stigma in the Arab world may be explained by absent or inefficient monitoring mechanisms of mental health legislations and policies within the health-care setting. Although integration of mental health services into the primary health care system is being gradually implemented as a step toward de-stigmatization of mental illness, more remains to be done to change the stigmatizing behavior of the health personnel toward mental illness.

Mental health authorities in the Arab world need to be more aware of the public perceptions explaining people’s fear and reluctance to seek mental health care, so as to ensure that the control and monitoring mechanisms at both the primary and mental health care levels foster a human rights, culturally competent, patient-friendly and non-stigmatizing model of mental health care.