Primary healthcare services

  • 文章类型: Journal Article
    远程医疗是一个有前途的解决方案,以提供公平和优质的初级卫生保健的挑战,尤其是在LMICs。这篇评论评估了2011年1月1日至2021年12月31日发表的关于印度初级保健远程保健干预措施的同行评审文献,Scopus,TRIP,谷歌学者,印第安人Kanoon,和Cochrane数据库大多数印度研究都集中在关键的健康问题上,例如母婴健康,心理健康,糖尿病,传染病,和高血压,主要通过患者教育,监测,和诊断。然而,缺乏对远程医疗成本效益的研究,供应商之间的沟通,以及领导力在质量和可及性方面的作用。目前的研究存在差距,包括小样本量和不一致的方法,这阻碍了远程医疗有效性的评估。印度多样化的医疗保健环境,技术限制,和社会因素进一步挑战远程医疗的采用。尽管监管努力,数字鸿沟和数据隐私等问题仍然存在。用情境意识应对这些挑战,技术驱动的方法对于通过印度的远程医疗加强医疗保健至关重要。
    Telemedicine is a promising solution to the challenges of delivering equitable and quality primary healthcare, especially in LMICs. This review evaluated peer-reviewed literature on telehealth interventions in Indian primary care published from Jan 1, 2011 to Dec 31, 2021, from PubMed, Scopus, TRIP, Google Scholar, Indian Kanoon, and Cochrane database The majority of Indian studies focus on key health issues like maternal and child health, mental health, diabetes, infectious diseases, and hypertension, mainly through patient education, monitoring, and diagnostics. Yet, there\'s a lack of research on telemedicine\'s cost-effectiveness, communication among providers, and the role of leadership in its quality and accessibility. The current research has gaps, including small sample sizes and inconsistent methodologies, which hamper the evaluation of telemedicine\'s effectiveness. India\'s varied healthcare landscape, technological limitations, and social factors further challenge telemedicine\'s adoption. Despite regulatory efforts, issues like the digital divide and data privacy persist. Addressing these challenges with a context-aware, technologically driven approach is crucial for enhancing healthcare through telemedicine in India.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    目的:评估患者对约旦初级卫生保健服务和提供者的满意度水平,并评估患者在社会人口统计学因素和初级卫生保健可及性方面的满意度差异。
    方法:本研究采用描述性横断面设计。
    方法:采用了一种方便的采样技术。
    方法:在2022年10月至12月期间,在安曼的9个初级保健中心采用了34项调查工具并分发给患者。
    结果:共有225名患者完成了调查。患者对初级卫生保健服务满意度的平均总分为25.22(SD=4.13)。在教育水平方面,对服务的满意度存在显著差异,探视原因,交通方式,停车场的可用性,并为残疾患者设计。此外,患者对初级卫生保健提供者的满意度的平均总分为22.85(SD=5.86).探视原因有显著差异,交通方式,和停车位的可用性。
    结论:提高基层医疗机构的患者满意度非常重要,卫生部应实施改善初级卫生保健服务质量的政策。
    OBJECTIVE: To evaluate patients\' satisfaction levels with primary healthcare services and providers in Jordan and assess differences in patients\' satisfaction in relation to sociodemographic factors and accessibility to primary healthcare.
    METHODS: A descriptive cross-sectional design was used in this study.
    METHODS: A convenient sampling technique was utilized.
    METHODS: A 34-item survey instrument was adopted and distributed to patients in nine primary healthcare centers in Amman in the period between October and December 2022.
    RESULTS: A total of 225 patients completed the survey. The mean total score for patient satisfaction with primary healthcare services was 25.22 (SD = 4.13). There were significant differences in satisfaction with services in terms of educational level, visitation reason, mode of transportation, availability of parking, and suitably designed for patients with disabilities. Furthermore, the mean total score for patient satisfaction with primary healthcare providers was 22.85 (SD = 5.86). There were significant differences in relation to visitation reason, mode of transportation, and parking space availability.
    CONCLUSIONS: It is important to improve patient satisfaction in primary healthcare facilities, and the Ministry of Health should implement policies for improving the quality of services provided by primary healthcare.
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  • 文章类型: Journal Article
    背景:在中国放松零COVID政策之后,2019年冠状病毒病(COVID-19)感染激增。本研究旨在调查北京居民在大范围暴发期间的感染状况和卫生服务利用情况。并探讨COVID-19影响卫生服务利用的因素。
    方法:于2023年1月13日至2月13日对北京居民进行了横断面调查,收集了有关社会人口学特征的信息,健康行为,COVID-19感染状态,利用卫生服务和抑郁症状。采用多变量Tobit回归进行数据分析。
    结果:在53.924名参与者中,14.7%的人年龄在60岁以上,63.7%为女性,84.8%为已婚。总的来说,在接受调查的53.924人中,有44.992人(83.4%)在2020-2023年期间感染了COVID-19,25.2%(13.587)寻求相应的卫生服务。大多数人(85.6%)选择了面对面医疗,而14.4%的人选择了基于互联网的医疗保健。在那些选择亲自医疗的人中,58.6%的人首选基层医疗机构,41.5%的人对治疗非常满意。影响卫生服务利用的因素包括女性(β=-0.15,P<0.001),60岁以上(β=0.23,P<0.01),非医护人员(β=-0.60,P<0.001),富人自评收入水平(β=0.59,P<0.001),有潜在疾病(β=0.51,P<0.001),独居(β=-0.19,P<0.05),抑郁症状(β=0.06,P<0.001)和健康的生活习惯,以及更长的感染持续时间,更高的感染数量和严重的症状。
    结论:随着COVID-19变得越来越频繁和不那么严重,提供安全和可获得的医疗保健仍然至关重要。老年人和有潜在疾病的弱势群体需要可靠的医疗服务。基层医疗资源优先排序和在线医疗服务在提高资源利用效率方面发挥了至关重要的作用。
    BACKGROUND: In the wake of China\'s relaxed zero-COVID policy, there was a surge in coronavirus disease 2019 (COVID-19) infections. This study aimed to examine the infection status and health service utilization among Beijing residents during a widespread outbreak, and to explore the factors that affected utilization of health services due to COVID-19.
    METHODS: A cross-sectional survey was conducted among Beijing residents from 13 January to 13 February 2023, collecting information on socio-demographic characteristics, health behaviours, COVID-19 infection status, utilization of health services and depressive symptoms. Multivariate Tobit regression was used for data analysis.
    RESULTS: Among the 53 924 participants, 14.7% were older than 60 years, 63.7% were female and 84.8% were married. In total, 44 992 of the 53 924 individuals surveyed (83.4%) contracted COVID-19 during 2020-2023, and 25.2% (13 587) sought corresponding health services. The majority of individuals (85.6%) chose in-person healthcare, while 14.4% chose internet-based healthcare. Among those who chose in-person healthcare, 58.6% preferred primary healthcare institutions and 41.5% were very satisfied with the treatment. Factors affecting health service utilization include being female (β = -0.15, P < 0.001), older than 60 years (β = 0.23, P < 0.01), non-healthcare workers (β = -0.60, P < 0.001), rich self-rated income level (β = 0.59, P < 0.001), having underlying disease (β = 0.51, P < 0.001), living alone (β = -0.19, P < 0.05), depressive symptoms (β = 0.06, P < 0.001) and healthy lifestyle habits, as well as longer infection duration, higher infection numbers and severe symptoms.
    CONCLUSIONS: As COVID-19 is becoming more frequent and less severe, providing safe and accessible healthcare remains critical. Vulnerable groups such as the elderly and those with underlying conditions need reliable health service. Prioritizing primary healthcare resources and online medical services have played a vital role in enhancing resource utilization efficiency.
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  • 文章类型: Case Reports
    前列腺癌是男性中第二常见的恶性肿瘤。尽管更频繁地转移到骨骼,区域淋巴结,还有肝脏,大脑也会受到影响。这些转移可以模拟脑膜瘤,使诊断更加困难。这里,我们报道了一例62岁男性患者,突然出现意识错乱和构音障碍,并自发消退,但因失忆.在神经学检查中,患者有眼球突出和眼睑下垂。他被送进了急诊室,他在那里做了颅脑CT,显示左侧颞前病变伴邻近水肿提示脑膜瘤,后来通过MRI证实。由于症状的恶化和病变大小的增加,建议全切除。解剖病理学研究显示低分化癌。为了研究原发性肿瘤,胸部CT,腹部,和骨盆;脊柱MRI;和前列腺特异性抗原的补充研究被要求。这些研究揭示了前列腺腺癌伴有脑和骨转移。诊断后,病人接受了激素治疗,化疗,和姑息性放疗。
    Prostate cancer is the second-most common malignancy in males. Despite more frequently metastasizing to the bone, regional lymph nodes, and liver, the brain can also be affected. These metastases can simulate meningiomas, making the diagnosis more difficult. Here, we report the case of a 62-year-old male with a sudden onset of confusion and dysarthria with spontaneous resolution but amnesia for the event. On a neurological exam, the patient had left exophthalmos and palpebral ptosis. He was referred to the emergency room, where he underwent a cranioencephalic CT, which revealed a left anterior temporal lesion with adjacent edema suggestive of meningioma, later confirmed by an MRI. Due to the worsening of the symptoms and an increase in the size of the lesion, total resection was proposed. The anatomopathological study revealed a poorly differentiated carcinoma. To study the primary tumor, a CT of the thorax, abdomen, and pelvis; a spine MRI; and a complementary study with prostate-specific antigen were requested. These studies revealed a prostate adenocarcinoma with brain and bone metastases. After the diagnosis, the patient underwent hormone therapy, chemotherapy, and palliative radiotherapy.
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  • 文章类型: Editorial
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  • 文章类型: Case Reports
    平滑肌瘤是从子宫肌层的平滑肌细胞和成纤维细胞中出现的非癌性肿瘤。它们是女性最常见的盆腔肿瘤,通常无症状。寄生平滑肌瘤已被定义为带蒂平滑肌瘤的不寻常变体。当出现症状时,平滑肌瘤可引起异常子宫出血,盆腔疼痛/压力,和生殖效应,如不孕症或不良妊娠结局。治疗因年龄而异,症状,以及保留生育能力的偏好。在这篇文章中,我们描述了一名58岁女性在初级卫生保健中接受定期宫颈癌筛查的案例.经客观审查,病人表现出腹部扩张和紧张,伴随着下肢水肿。这些症状与过去几个月的疲劳和体重增加有关。随后的调查导致剖腹探查,发现腹部有大量肿块,直径约45厘米,重35公斤。这些发现暗示了寄生性平滑肌瘤。
    Leiomyomas are non-cancerous tumors emerging from the smooth muscle cells and fibroblasts of the myometrium. They are the most common pelvic tumors in females and are usually asymptomatic. Parasitic leiomyomas have been defined as unusual variants of pedunculated leiomyomas. When symptomatic, leiomyomas can cause abnormal uterine bleeding, pelvic pain/pressure, and reproductive effects, such as infertility or adverse pregnancy outcomes. Treatment varies depending on age, symptoms, and the preference to preserve fertility. In this article, we describe the case of a 58-year-old woman who presented for a scheduled cervical cancer screening in primary healthcare. Upon objective examination, the patient exhibited a distended and tense abdomen, along with edema in the lower limbs. These symptoms were associated with fatigue and weight gain over the last few months. Subsequent investigation led to an exploratory laparotomy which revealed a massive abdominal mass, measuring approximately 45 cm in diameter and weighing 35 kg. The findings were suggestive of a parasitic leiomyoma.
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  • 文章类型: Journal Article
    背景:获得基本药物是全民健康覆盖的关键组成部分。然而,苏丹基本药物的供应没有得到很好的研究。同样,大多数苏丹人缺乏健康保险,使自付支出成为毒品融资的主要来源。因此,苏丹的药品负担能力值得怀疑,只有30%的人口被公共卫生服务或公共健康保险覆盖。我们进行了这项研究,以评估喀土穆州公共部门医疗机构中基本药物的可用性和价格。此外,这项研究旨在评估患者对基本药物的感知负担能力,以及公共设施的住宿和可接受性。
    方法:在喀土穆州三个地区的30个初级卫生保健机构进行了一项横断面研究。在每个中心的药房内,标准化清单评估了从苏丹国家基本药物清单中选择的21种基本药物的可获得性和可负担性,并评估了其储存条件。此外,从所有药房中选择630名患者进行退出访谈,评估他们的感知可及性,可接受性,住宿,和基本药物的可负担性。通过Kobo工具箱收集数据,并使用SPSS版本26进行分析。
    结果:参与者对可访问性的评分,负担能力,住宿,可接受性分别为3.7/5、1.5/4、5/6和5.4/6,26.7%的完全访问率和一些指数之间的弱相关性。成人和儿科药物的总体可获得性为36.8%6.7%,分别。在所消耗的19种药物中,10种和16种药物的单疗程治疗费用超过了参保和未参保患者的每日工资,中位数价格比分别为16.4和62.8。此外,药房区的条件被发现质量很好,然而,40%的商店的储藏室没有运作。
    结论:由于高昂的价格和身体不可用,患者获得所需药物的机会有限。初级保健能力不能满足公民的需求。患者访问变量的结果(可访问性,住宿,接受,和负担能力)与低收入国家相当。确保获得免费药品可能会提高患者对医疗保健服务的满意度,并减少私人药品支出,这是一个长期的,实现苏丹全民健康覆盖的可持续方式。
    Access to essential medicines is a critical component of universal health coverage. However, the availability of essential medicines in Sudan isn\'t well studied. As well, most Sudanese people lack health insurance, making out-of-pocket spending the primary source of drug financing. Therefore, the affordability of medicines in Sudan is questionable, with only 30% of the total population being covered by a public health service or public health insurance. We undertook this study to assess the availability and prices of essential medicines in public-sector health facilities in Khartoum state. Moreover, this study aims at assessing patients\' perceived affordability of essential medicines, and accommodation and acceptability of the public facility.
    A cross-sectional study was carried out at 30 primary healthcare facilities\' drug dispensaries across three districts in Khartoum state. Within each Centre\'s dispensary unit, a standardized checklist evaluated the availability and affordability of 21 essential medicines selected from Sudan\'s national essential medicines list and assessed their storage conditions. Furthermore, 630 patients were selected from all dispensary units for an exit interview that assessed their perceived accessibility, acceptability, accommodation, and affordability of essential medicines. Data were collected through the Kobo toolbox and analyzed using SPSS version 26.
    Participants\' ratings of accessibility, affordability, accommodation, and acceptability were 3.7/5, 1.5/4, 5/6, and 5.4/6, respectively, with a 26.7% full access and weak correlation between some of the indices. The overall availability of adults and pediatric medicines was 36.8% 6.7%, respectively. Cost of a single course of treatment for 10 and 16 drugs out of the 19 drugs consumed exceeds the daily wage of insured and uninsured patients, with a median price ratio of 16.4 and 62.8, respectively. Moreover, the dispensary area conditions were found to be of good quality, yet the storerooms were not functioning in 40% of the outlets.
    Patients had limited access to their needed drugs due to high prices and physical unavailability, and primary healthcare capacities are not meeting the demands of citizens. The outcomes for the patients\' access variables (accessibility, accommodation, acceptance, and affordability) are comparable to those in countries with low incomes. Ensuring access to free medicines is likely to improve patients\' satisfaction with healthcare services and reduce private expenditure on medicines, which is a long-term, sustainable way towards universal health coverage in Sudan.
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  • 文章类型: Journal Article
    健康促进(HP)是世界家庭医生组织定义的全科医生(GP)能力的一部分。HP在其实践中的实施并不令人满意。
    这项研究的目的是探索全科医生的知识,摩洛哥对惠普在初级医疗保健服务中的态度和做法。
    使用在线自我管理问卷进行了一项横断面研究,包括:知识,全科医生对惠普的态度和做法。进行描述性和双变量分析。
    二百四十名全科医生回答了我们的问卷,性别比例为1.12,平均年龄为40.46±9.05岁。超过一半的参与者认为HP是一个与预防无关的概念,70.4%的人认为HP是指生物医学模式。在1-5的Likert量表上,HP知识水平为2.71±1.13。人们讨论最多的话题是烟草,酒精,超重和肥胖。发现全科医生在生活方式行为中的能力与这种能力的实践之间存在统计学上的显着关联。
    全科医生的知识仍然不足,他们的实践更多地集中在他们认为有能力的领域,这需要在HP中实施针对GP技能发展的特定培训。
    UNASSIGNED: Health promotion (HP) is a part of the general practitioners\' (GPs) competencies defined by the World Organization of Family Doctors. The implementation of HP in their practice is unsatisfactory.
    UNASSIGNED: The aim of this study was to explore GPs knowledge, attitudes and practices in Morocco about HP at the primary healthcare services.
    UNASSIGNED: A cross-sectional study was conducted using an online self-administrated questionnaire including, knowledge, attitudes and practices of GPs toward HP. Descriptive and bivariate analyses were conducted.
    UNASSIGNED: Two hundred and forty GPs responded to our questionnaires, the sex ratio was 1.12 with an average age of 40.46 ± 9.05 years. More than half of our participants perceived HP as a concept indistinct from prevention, 70.4% believed that HP refers to the biomedical model. On a Likert scale of 1-5, the level of HP knowledge was 2.71 ± 1.13. The most discussed topics with the population were tobacco, alcohol, overweight and obesity. Statistically significant association was found between the competencies of GPs in lifestyle behaviours and the practice of this competence.
    UNASSIGNED: The knowledge of GPs remains insufficient, and their practices focus more on the areas in which they feel competent, which requires the implementation of specific training for the development of GPs skills in HP.
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  • 文章类型: Journal Article
    印度的医疗保健系统迫切需要一种新的医疗保健提供模式,以增加医疗保健的可及性并改善边缘化人群的健康状况。初级保健中心(PHCs)的难以接近和利用不足对生活在偏远地区的人们造成了不成比例的影响。因此,对于设计师来说,这是当务之急。工程师,卫生专业人员,和政策制定者以协作的心态共同制定创新的干预措施,以可持续地管理整个PHCs的可访问性,促进预防性健康,从而改善难以到达的社区的健康结果。本文研究了印度背景下关于初级医疗保健障碍的现有文献,PHCs失败的原因和前进的方向。本文进一步分析了有关现有移动医疗单位(MMU)作为常规PHC的替代解决方案的文献,并尝试提取与现有的常规静态PHC相比,提出移动初级健康中心(mPHC)的主要经验教训。目的是找出现有文献中的研究空白,并尝试为未来的研究人员解决相同的问题。设计师,工程师,卫生专业人员和政策制定者考虑提出移动初级保健中心(mPHC)的想法,作为向服务不足的社区提供基本医疗服务的主要交付模式。
    Indian healthcare system is in immediate need of a new healthcare delivery model to increase healthcare accessibility and improve the health outcomes of the marginalized. Inaccessibility and underutilization of Primary Health Centers (PHCs) disproportionately affect people living in remote areas. It is thus imperative for the designers, engineers, health professionals, and policymakers to come together with a collaborative mindset to develop innovative interventions that sustainably manage the accessibility of PHCs at large, promote preventive health, and thus improve the health outcomes of hard-to-reach communities. This article examines the available literature on barriers to primary healthcare in Indian context, the reason of failure of PHCs and the way forward. The article further analysis literature on existing Mobile Medical Units (MMUs) as an alternate solution to conventional PHCs and attempt to extract the major lessons to propose a mobile Primary Health Center (mPHC) in contrast to the existing conventional static PHCs. The intention is to find out the research gaps in the existing literature and try to address the same for future researchers, designers, engineers, health professionals and policy makers to think forward to make this idea of a mobile Primary Health Center (mPHC), as the main delivery model to cater basic healthcare services to the underserved communities.
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