Articles: community-health-services.
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Cochrane Db Syst Rev · Jul 2023
ReviewHealthcare workers' perceptions and experiences of primary healthcare integration: a scoping review of qualitative evidence.
Primary healthcare (PHC) integration has been promoted globally as a tool for health sector reform and universal health coverage (UHC), especially in low-resource settings. However, for a range of reasons, implementation and impact remain variable. PHC integration, at its simplest, can be considered a way of delivering PHC services together that sometimes have been delivered as a series of separate or 'vertical' health programmes. Healthcare workers are known to shape the success of implementing reform interventions. Understanding healthcare worker perceptions and experiences of PHC integration can therefore provide insights into the role healthcare workers play in shaping implementation efforts and the impact of PHC integration. However, the heterogeneity of the evidence base complicates our understanding of their role in shaping the implementation, delivery, and impact of PHC integration, and the role of contextual factors influencing their responses. ⋯ This scoping review provides a systematic, descriptive overview of the heterogeneity in qualitative literature on healthcare workers' perceptions and experience of PHC integration, pointing to diversity with regard to country settings; study types; client populations; healthcare worker populations; and intervention focus, scope, and strategies. It would be important for researchers and decision-makers to understand how the diversity in PHC integration intervention design, implementation, and context may influence how healthcare workers shape PHC integration impact. The classification of studies on the various dimensions (e.g. integration focus, scope, strategy, and type of healthcare workers and client populations) can help researchers to navigate the way the literature varies and for specifying potential questions for future qualitative evidence syntheses.
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Chronic kidney disease (CKD) is prevalent in the UK, associated with significant mortality and morbidity, and disproportionately affects minority ethnic groups. The most common causes for CKD are diabetes and hypertension. An estimated glomerular function (eGFR) blood test and an albumin creatinine ratio (uACR) urine test can be used to assess the level of CKD and predict the risk of adverse outcomes such as cardiovascular disease, end stage renal failure, and death. However, UK National CKD audit data suggest that only 30% of those with hypertension have a recorded uACR. Our quality improvement project working with community stakeholders and Healthy.io digital enterprise will evaluate the feasibility of uACR self-testing in the community. ⋯ Improving equity in uACR testing through quality improvement tools can deliver a sustainable project for improving patient renal care. Leveraging innovative methods provides the potential for effective, equitable, and efficient services.
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There is a paucity of research about how under 5-year-olds utilise primary care in the UK, despite having one of the highest consultation rates of any age group. A greater understanding of the factors influencing health within this age group can inform targeted health promotion. ⋯ Most reasons for attendance for children under 5 years to primary care are for acute, self-limiting conditions. Some of these could potentially be managed by increasing access to community care services. By focusing on the influence of the broader determinants of health, health promotion efforts have the opportunity to reduce barriers to health care and improve outcomes.
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Understanding the general public's view about Domestic Violence and Abuse (DVA) is vital, as it would help with the development of targeted interventions and effective public policies to tackle this rising problem in society. ⋯ Community-dwelling adults acknowledge the impacts of abuse, but many fail to recognise specific instances or events in their daily lives contributing to DVA. Raising public awareness, particularly in children through the school curriculum, highlighting existing support services and introducing the routine use of short screening tools for DVA in health and social care settings can increase awareness, early identification and signpost to effective interventions. Sustained, multi-level community-facing interventions are recommended to reduce the stigma and fears associated with DVA.