DOI: 10.1136/bmjopen-2020-039674
Objectives
The current COVID-19 pandemic, as well as the measures taken to control it, have a profound impact on healthcare. This study was set up to gain insights into the consequences of the COVID-19 outbreak on the core competencies of general practice, as they are experienced by general practitioners (GPs) on the frontline.
Design, setting, participants
We performed a descriptive study using semistructured interviews with 132 GPs in Flanders, using a topic list based on the WONCA definition of core competencies in general practice. Data were analysed qualitatively using framework analysis.
Results
Changes in practice management and in consultation strategies were quickly adopted. There was a major switch towards telephone triage and consults, for covid-related as well as for non-covid related problems. Patient-centred care is still a major objective. Clinical decision-making is largely focused on respiratory assessment and triage, and GPs feel that acute care is compromised, both by their own changed focus and by the fact that patients consult less frequently for non-covid problems. Chronic care is mostly postponed, and this will have consequences that will extend and become visible after the corona crisis. Through the holistic eyes of primary care, the current outbreak-as well as the measures taken to control it-will have a profound impact on psychological and socioeconomic well-being. This impact is already visible in vulnerable people and will continue to become clear in the medium and long terms. GPs think that they are at high risk of getting infected. Dropping out and being unable to contribute their part or becoming virus transmitters are reported to be greater concerns than getting ill themselves.
Conclusions
The current times have a profound impact on the core competences of primary care. Although the vast increase in patients soliciting medical help and the necessary separate covid and non-covid flows have been dealt with, GPs are worried about the continuity of regular care and the consequences of the anticovid measures. These may become a threat for the general health of the population and for the provision of primary healthcare in the near and distant future.
Keywords: organisation of health services; primary care; qualitative research.
DOI: 10.1016 / j.pcd.2007.07.009
Aim
The EUCCLID study aims to compare the quality of type 2 diabetes (DM2) care and the prevalence of complications in primary care DM2 patients in Europe.
Design
A cross-sectional survey consisting of three parallel studies: (1) study on actual clinical practice; (2) study on patient's perspective of diabetes care; (3) study on general practitioner's perspective of diabetes care.
Methods
Patients will be randomly selected from a list of all patients known to the participating GPs with DM2 for whom the GP is the main diabetes care provider. Exclusion criteria will include people with type 1 diabetes mellitus, diabetes of pregnancy, serious mental illness, unable to complete a questionnaire in national language or unable to give written informed consent. Approximately 12,000 patients will be included. Participants will have a detailed medical history and anthropometric measurements, blood and urine will be collected and questionnaires will be taken. Endpoints will include quality indicators of clinical DM2 care, prevalence of diabetic complications, knowledge, attitudes, barriers and behaviour affecting good control in DM2 patients, quality of life and patients' satisfaction with diabetes care. We will also determine primary care physician's attitudes, behaviour and perception of barriers to deliver effective diabetes care.
DOI: 10.1016/j.pcd.2009.02.001
Aims
To develop and implement a group self-management education programme for people with type 2 diabetes at the community level in primary care. This pilot-study intended to evaluate the feasibility, acceptability and long-term effects (12-18 months) of this programme on emotional distress, HbA1c, BMI and actual behaviour.
Methods
An empowerment-based, theory-driven education programme was evaluated in a before-after design. The programme focused on behaviour assessment, goal-setting, problem solving and tailored information. A diabetes specialist nurse conjointly with a dietician or psychologist led five 2-hour sessions and a follow-up meeting after 3 months.
Results
Forty-four people participated in 5 groups. BMI decreased with 0.45 kg/m(2) (95%CI 0.01-0.89) at 12-month and with 0.53 kg/m(2) (95%CI 0.02-1.04) at 18-month follow-up. HbA1c declined from 7.4% (+/-1.3) to 6.8% (+/-0.8) (p=0.040) and the PAID-score diminished from 28 (+/-20) to 18 (+/-13) (p=0.006) at 12-month post-intervention. These changes were only partly sustained at 18-month follow-up. Actual behaviour changed modestly.
Conclusion
Introducing the group education programme in primary healthcare is worthwhile (feasibility and effectiveness). A detailed description of the intervention is offered. Further research should explore the actual education process in greater depth.
The current study aimed to examine the health-related quality of life (HRQoL) and to identify its related factors amongst adult patients with type 2 diabetes mellitus (T2DM). This cross-sectional study recruited randomly 519 patients diagnosed with T2DM for at least 6 months in the Family medicine center (FMC) of Agricultural General Hospital in Hanoi, Vietnam. The Short Form 36 (SF-36) health survey was used to measure their HRQoL. The female patients had lower physical and mental scores than the male patients. Patients with older age, comorbidity, and insulin treatment were more likely to have lower HRQoL. Meanwhile, educational attainment and having frequent exercise were positively associated with HRQoL.
Keywords: Vietnam; comorbidity; diabetes; quality of life; type 2 diabetes mellitus.
DOI: 10.1017/S1463423619000641
Aim
The aim of this position paper is to assist primary health care (PHC) providers, policymakers, and researchers by discussing the current context in which palliative health care functions within PHC in Europe. The position paper gives examples for improvements to palliative care models from studies and international discussions at European Forum for Primary Care (EFPC) workshops and conferences.
Background
Palliative care is a holistic approach that improves the quality of life of patients and their families facing problems associated with terminal illness, through the prevention and relief of suffering by means of early identification and diligent assessment and treatment of pain and other problems, whether physical, psychosocial, or spiritual. Unfortunately, some Europeans, unless they have cancer, still do not have access to generalist or specialist palliative care.
Methods
A draft of this position paper was distributed electronically through the EFPC network in 2015, 2016, and 2017. Active collaboration with the representatives of the International Primary Palliative Care Network was established from the very beginning and more recently with the EAPC Primary Care Reference Group. Barriers, opportunities, and examples of good and bad practices were discussed at workshops focusing on palliative care at the international conferences of Southeastern European countries in Ljubljana (2015) and Budva (2017), at regular conferences in Amsterdam (2015) and Riga (2016), at the WONCA Europe conferences in Istanbul (2015), Copenhagen (2016), and Prague (2017), and at the EAPC conference in Madrid (2017).
Findings
There is great diversity in the extent and type of palliative care provided in primary care by European countries. Primary care teams (PCTs) are well placed to encourage timely palliative care. We collected examples from different countries. We found numerous barriers influencing PCTs in preparing care plans with patients. We identified many facilitators to improve the organization of palliative care.
Keywords: palliative care; position paper; primary care.
DOI: 10.1136/bmjopen-2016-013076
Objectives
We evaluated the effectiveness of European chronic care programmes for type 2 diabetes mellitus (characterised by integrative care and a multicomponent framework for enhancing healthcare delivery), compared with usual diabetes care.
Design
Systematic review and meta-analysis.
Data sources
MEDLINE, Embase, CENTRAL and CINAHL from January 2000 to July 2015.
Eligibility criteria
Randomised controlled trials focussing on (1) adults with type 2 diabetes, (2) multifaceted diabetes care interventions specifically designed for type 2 diabetes and delivered in primary or secondary care, targeting patient, physician and healthcare organisation and (3) usual diabetes care as the control intervention.
Data extraction
Study characteristics, characteristics of the intervention, data on baseline demographics and changes in patient outcomes.
Data analysis
Weighted mean differences in change in HbA1c and total cholesterol levels between intervention and control patients (95% CI) were estimated using a random-effects model.
Results
Eight cluster randomised controlled trials were identified for inclusion (9529 patients). One year of multifaceted care improved HbA1c levels in patients with screen-detected and newly diagnosed diabetes, but not in patients with prevalent diabetes, compared to usual diabetes care. Across all seven included trials, the weighted mean difference in HbA1c change was -0.07% (95% CI -0.10 to -0.04) (-0.8 mmol/mol (95% CI -1.1 to -0.4)); I2=21%. The findings for total cholesterol, LDL-cholesterol and blood pressure were similar to HbA1c, albeit statistical heterogeneity between studies was considerably larger. Compared to usual care, multifaceted care did not significantly change quality of life of the diabetes patient. Finally, measured for screen-detected diabetes only, the risk of macrovascular and mircovascular complications at follow-up was not significantly different between intervention and control patients.
Conclusions
Effects of European multifaceted diabetes care patient outcomes are only small. Improvements are somewhat larger for screen-detected and newly diagnosed diabetes patients than for patients with prevalent diabetes.
Keywords: Europe; Managed care; Meta-analysis; Systematic review; Type 2 diabetes mellitus.
DOI: 10.5334/ijic.4646
Background
Most current care models are disease- or symptom-focused and mostly do not account for the individual needs of patients with chronic diseases. The aim of this study was to develop an innovative, evidence-based and expert-based practice model for the management of patients with type 2 diabetes mellitus.
Method
An iterative approach was used combining systematic literature search with qualitative methods, including a standardised survey of experts in chronic care (n = 92), an expert workshop of professionals (n = 22) and a multilingual online survey (n = 659). Using three consensus meetings involving researchers, policy makers and experts in chronic care, a limited number of core components and care recommendations was set up to develop a new chronic care model.
Results
The developed 'MANAGE CARE MODEL' includes aspects of the health and social care system, resources derived from the living environment, aspects of health promotion and prevention, as well as an expanded understanding of improved outcomes as an integral part of chronic care.
Conclusion
The MANAGE CARE MODEL provides guidance for the development and implementation of chronic care programs, regional networks and national strategies. Future research is needed to validate the model as an instrument of regional chronic care management.
Keywords: chronic care; chronic care model; integrated care; prevention and health promotion; type 2 diabetes mellitus.
DOI: 10.1080/14739879.2016.1222505
Background
The development of improved primary care systems around the world has received increased attention as a step towards improved health care for all. Vietnam is engaged in efforts to improve health care quality with a focus on primary care and Family Medicine training. New methods of assessment are needed to accurately measure competency in primary care practice.
Methods
A behaviourally-anchored rating scale was developed focused on core primary care principles for use in direct observation at the site of primary care delivery. This assessment tool was implemented with trainees in Family Medicine and a cohort of physicians not trained in Family Medicine.
Results
The tool measured statistically significant differences in selected behaviours related to communication skills and comprehensiveness among Family Medicine trained physicians. No significant differences were measured in other primary care domains.
Conclusion
This behaviourally-anchored rating scale is a feasible tool for use in direct observation of primary care practice delivery in developing settings. More work is needed to refine this tool and assess its sensitivity, validity and reliability.
Keywords: primary care, family medicine, assessment, Vietnam, post-graduate training
DOI: doi.org/10.5539/jsd.v10n5p85
To achieve the Sustainable Development Goals, particularly to promote healthy living and well-being for all ages, we must ensure a high quality of healthcare services at primary facilities. However, the shortage of healthcare workers in primary facilities is a problem in many countries, including Vietnam. Despite concerns about the low job satisfaction of health workers and value of altruism in this field, no existing research has thus far addressed its effect on job satisfaction. This study thus contributes to the body of knowledge on healthcare workers’ job satisfaction by observing the role of altruism.
We conducted a quantitative analysis by using data collected from healthcare workers employed at primary facilities in central Vietnam in 2014. The survey administered to healthcare workers (n=241) included a hypothetical dictator game questionnaire to elicit their level of altruism. We then used an ordered probit model to examine the factors associated with healthcare workers’ job satisfaction, focusing particularly on altruism by controlling for both individual-level attributes and the condition of their workplaces.
We found that a higher level of altruism is associated with lower job satisfaction. Further analysis revealed that more altruistic workers are also likely to have a stricter self-evaluation of healthcare quality, including the availability of drugs. Altruistic healthcare workers may be frustrated when working in environments in which resources are constrained and workers cannot perform to their full ability despite a wish to help others.
DOI: 10.1371/journal.pone.0191181
Objective
To adapt the consumer version of the Primary Care Assessment Tool (PCAT) for Vietnam and determine its internal consistency and validity.
Design
A quantitative cross sectional study.
Setting
56 communes in 3 representative provinces of central Vietnam.
Participants
Total of 3289 people who used health care services at health facility at least once over the past two years.
Results
The Vietnamese adult expanded consumer version of the PCAT (VN PCAT-AE) is an instrument for evaluation of primary care in Vietnam with 70 items comprising six scales representing four core primary care domains, and three additional scales representing three derivative domains. Sixteen other items from the original tool were not included in the final instrument, due to problems with missing values, floor or ceiling effects, and item-total correlations. All the retained scales have a Cronbach’s alpha above 0.70 except for the subscale of Family Centeredness.
Conclusions
The VN PCAT-AE demonstrates adequate internal consistency and validity to be used as an effective tool for measuring the quality of primary care in Vietnam from the consumer perspective. Additional work in the future to optimize valid measurement in all domains consistent with the original version of the tool may be helpful as the primary care system in Vietnam further develops
DOI: 10.1017/S1463423619000458
Aim
To adapt the provider version of the Primary Care Assessment Tool (PCAT) for Vietnam and determine its internal consistency and validity.
Background
There is a growing need to measure and explore the impact of various characteristics of health care systems on the quality of primary care. It would provide the best evidence for policy makers if these evaluations come from both the demand and supply sides of the health care sector. Comparatively more researchers have studied primary care quality from the consumer perspective than from the provider’s perspective. This study aims at the latter.
Method
Our study translated and adapted the PCAT provider version (PCAT PE) into a Vietnamese version, after which a cross-sectional survey was conducted to examine the feasibility, internal consistency and validity of the Vietnamese PCAT provider version (VN PCAT PE). All general doctors working at 152 commune health centres in Thua Thien Hue province had been selected to participate in the survey.
Findings
The VN PCAT PE is an instrument for evaluation of primary care in Vietnam with 116 items comprising six scales representing four core primary care domains, and three additional scales representing three derivative domains. From the translation and cultural adaptation stage, two items were combined, two items were removed and one item was added. Six other items were excluded due to problems in item-total correlations. All items have a low non-response or ‘don’t know/don’t remember’ response rate, and there were no floor or ceiling effects. All scales had a Cronbach’s alpha above 0.80, except for the Coordination scale, which still was above the minimum level of 0.70.
Conclusion
The VN PCAT PE demonstrates adequate internal consistency and validity to be used as an effective tool for measuring the quality of primary care in Vietnam from the provider perspective.
Keywords: assessment, primary care quality, provider perspectives
DOI: 10.1186/s12913-019-4089-y
Background
Patient experience with primary health care services can vary markedly between different types of health care facilities, even within the same country setting. Given known benefits of high quality primary health care, the performance of these facilities may significantly impact population health. The aim of this study was to compare the quality of primary care in different types of health facilities as experienced by Vietnamese consumers.
Methods
1662 people who utilized primary health care services at least once over the past two years in various types of facilities in central Vietnam were surveyed in a cross-sectional study using the Vietnamese version of the Primary Care Assessment Tool (VN PCAT-AE) to assess overall primary care quality as well as several different domains of high quality primary care services.
Results
Commune health centers were associated with the highest overall primary care quality (PCAT expanded score 21.07, p < 0.001) as well as high scores in nearly all individual domains of primary care quality experienced by consumers compared with other types of facilities. Conversely, private facilities such as private clinics and pharmacies were rated lowest overall (PCAT expanded score 18.45, p < 0.05 and 16.90, p < 0.001 respectively). District hospitals and other government hospitals (PCAT expanded score 20.10 and 19.72 respectively) were reported as the best quality in comprehensiveness of available services (p < 0.001). Polyclinics performed quite well in comprehensiveness of services available (3.11) and first contact-access (2.79) but less so in other domains, especially in cultural competency (1.87).
Conclusions
The high quality of primary care services experienced by consumers in commune health centers compared with other facilities gives Vietnam ample reason to promote greater use of these community-based primary care facilities. Populations may benefit most from building and strengthening grassroots networks of such community-based health centers as an effective solution for overcrowding at hospitals while simultaneously providing better overall health outcomes.
DOI: 10.1155/2018/6326984
Introduction
The objective of this study is to describe the prevalence, awareness, treatment, and control of hypertension and its associated risk factors in (Central) Vietnam.
Methods
In this cross-sectional study, a multistage sampling was used to select 969 participants from the general population aged from 40 to 69 years. The cardiovascular risk factors were collected throughout the interviews with a standardized questionnaire. Multivariate logistic regression analysis was conducted to test the relationship between the prevalence, awareness, treatment, and control of hypertension and the prevalence of risk factors.
Results
The prevalence of hypertension was 44.8%. It was higher in men than in women (51.3% versus 39.7%, < 0.001). In total 67.3% (74.5% in women, 60.1% in men; = 0.001) of the participants were aware of their hypertension, 33.2% (37.5% in women, 28.9% in men; = 0.01) of the participants were treated, and 12.2% (16.7% in women, 7.8% in men; < 0.001) of the hypertensive participants’ hypertension was controlled. Age, gender, place of residence, body mass index, and diabetes were found to be independent risk factors for hypertension.
Conclusion
The prevalence of hypertension in Vietnam is high, and the proportion of treated and controlled patients is rather low.
DOI: 10.1371/journal.pone.0241311
Introduction
Measuring the performance of a primary care system is one of the very first steps to find out whether there is room for improvement. To obtain an objective and comprehensive view, this measurement should come from both the supply and demand sides of the system. Patients’ experiences of primary care have been studied around the world, but much less energy has been invested in researching providers’ perspectives. This research aims to explore how primary care physicians working at commune health centers in Vietnam evaluate their performance and their opinions on how to improve the quality of primary care services.
Materials and methods
First, a quantitative study was conducted using the validated Vietnamese PCAT questionnaire—provider expanded version (VN PCAT PE) targeting all primary care physicians (PCPs) working at commune health centers in a province of Central Vietnam. Next, a qualitative study was carried out, consisting of in-depth interviews with PCPs, to better understand the results of the quantitative survey and gain insight on barriers of primary care services and how to overcome them.
Results
In the quantitative portion of our study, 150 PCPs rated the quality of ongoing care and first contact in CHCs as the best (3.09 and 3.11 out of 4, respectively), and coordination as the worst performing core domain (2.53). Twenty-two PCPs also participated in our qualitative research. In regards to challenges that primary care physicians face during their daily practice, three central themes emerged: 1) patient factors such as client attitude and knowledge, 2) provider factors such as the burden of administrative work and lack of training opportunities, and 3) contextual factors such as low income and lack of resources including medicines and diagnostics. Participants recommended more health promotion campaigns in the media, increasing the number of services available at CHCs (such as being able to take blood samples), reducing the workload related to administration for CHC leaders, greater government subsidies, and providing more training courses for PCPs.
Conclusions
Findings from this study offer a valuable view from the supply-side of the primary care system, specifically those who directly deliver primary care services. Along with the earlier study on consumers’ evaluation of the Vietnamese primary care system, and literature from other low and middle-income countries, these findings offer emerging evidence for policymakers to improve the quality of primary care in Vietnam.
Objectives
Diabetes mellitus (DM) is a chronic disease with severe complications and high mortality. In Vietnam, the incidence of DM is rapidly increasing at alarming rates and has almost doubled within the last 10 years. Self-care has been explored in the literature as an important construct to achieve good metabolic control and well management of DM. This study aimed to investigate the self-care practices of individuals with DM.
Methods
A cross-sectional study is conducted with 513 patients diagnosed DM in the 4 district hospitals of Thua Thien Hue provinces. The Vietnamese version of the Summary of Diabetes Self-care Activities (SDSCA) was used.
Results
The specific self-care dimensions reported more desirable were following a healthy diet (57.1%) and medication adherence (93.2%). The proportion of people with frequent behaviors towards blood glucose testing, foot care, and physical activities were very low, with 0.4%, 33.9%, and 31.6% respectively. 32.4% of diabetes patients having good adherence to the overall of self-care activities.
Conclusion
The results show a big gap in specific self-care activities among patients with DM. It is strongly recommended to enhance the awareness and practice of self-care activities among diabetes patients by developing effective education strategies and activities of diabetes patient groups.
Key words: Diabetes mellitus type 2, self-care behaviors, self-managment
Patient-centered care is widely acknowledged as an important goal in healthcare delivery. Research has demonstrated that patient perceptions of patient-centred care can be linked to clinical and long-term outcomes in addition to being a useful metric for quality improvement efforts.
Objectives
Methods
A cross sectional descriptive study was conducted in 313 patients living in Thua Thien Hue province. A structured questionnaire was use to investigate 4 main domains of patient-centered care: Information and Education, Relationships with doctors and other health professionals, making decisions, motivate patients about self-management. We used test ANOVA to analyze the association between patient-centered care and health care utilization among participants (p < 0.05).
Results
The percentage of good patient-centered care (≥ 3.75 points) was 43.1% (Mean = 3.58 (0.57)). Patients using health services at the commune health centers had a higher experience in patient-centered care compared to district, province and central hospitals (p < 0.005). Domains “Encourage patients to take care of themselves” and “Relationship factor with doctors” were evaluated low. There were statistically significant associations between patient-centered care and primary health care facilities, quality of life utilization of periodic health checkup, and patient activation in health care (p <0.05).
Conclusion
Out study illustrates that patients’ perspectives and experiences of patient-centered care are still low. There is a need to improve communication and counseling skills of health care providers and increase patient motivation for self-care
Key words: patient-centered care, primary care, health care utilization
