The Rational Drug Use Training Project is a district-oriented programme designed to improve rational drug use among primary health care prescribers in the South African public sector. This thesis describes the development of the project and details the initial implementation study in 3 facilities in Region B of KwaZulu-Natal. This was a small before-after study, with no control. There were three components: 1. A series of easily collectable drug use indicators, adapted from those developed by WHO/INRUD. These allow primary health care staff to monitor their prescribing patterns in a district or facility. Ninety sets of prescribing indicators were collected as a baseline at 3 facilities in KwaZulu-Natal in December 1996, by the district trainers and the Rational Drug Use Training Project staff. The process was repeated in March 1997, after the training intervention, by the district trainers alone. 2. The intervention was a 2-day training workshop in rational drug use. This is problem-based and trained on-site in primary health facilities. Training was done by 8 district trainers from Region B who were taught to present the workshop by the Rational Drug Use Training Project staff. The workshop covers principles of prescribing, use of standard treatment guidelines, principles of clinic stock management and principles of good dispensing. Staff are encouraged to develop their self-learning skills through questioning, and seeking answers to clinical and drug related queries. 3. A set of resources, including texts, treatment guidelines and information centres, to provide quality, safe and unbiased drug information, are made accessible to staff at primary care level. These are available by post, telephone or e-mail. The Primary Care Medicines Resource Centre at the University of Durban-Westville was developed as a result of this study. Significant improvements in prescribing habits were noticed after the study. There was an increase in the percentage of drugs prescribed by their generic names (p=0.000); an increase in the number of medications adequately labelled (p=0.0132); a decrease in the cost of prescriptions (p=0.0134); and a decrease in the number of prescriptions that did not follow standard treatment guidelines at all for that diagnosis (p=0.0109). The Mann-Whitney U- test was used for statistical analysis. There were no significant changes in the average number of drugs per prescription; the percentage of drugs from the Essential Drugs List; and the number of prescriptions that completely followed standard treatment guidelines. Qualitative feedback was favourable too. This was a difficult study to undertake. The staff and funding organisation, Health Systems Trust, fell outside of the provincial health structure and met resistance at that level. Regional politics shaped the programme's design. District trainers needed for the cascade approach were not available. District staff remained entrenched in a traditional health hierarchy and found it difficult to function as a team. The will of district prescribing staff to learn was low. Rational drug use training is only one of a number of essential elements of in-service training urgently needed by these staff. Despite these problems, quantitative and qualitative success was shown. The Training Manual, developed in support of the training, has been in demand. The Primary Care Medicines Resource Centre is growing. Primary care prescribers have been motivated to monitor their own practices and manage their own clinic stock. The project is a successful example of multi-disciplinary and institutional collaboration. The Rational Drug Use Training Project has expanded to eight other health districts in 1997. A list of criteria, such as the need for a district trainer, have been set. These must be met by the district before training will commence. The project is a resource for Initiative for Sub-District Support, a joint district development programme of Health System Trust and the Department of Health. Most expansion in 1998 will be through this initiative. The difficulties encountered and achievements made during this small study will be used to support, and hopefully strengthen, the development of the primary health care oriented district health system, so urgently needed by the South African population.

Masters of Commerce / The provision of health care in South Africa is undergoing major restructuring. The aim is to achieve substantial, visible and sustainable improvements to the efficiency and accessibility of primary healthcare (PHC) services for all South Africans. One of the country's most critical problems is the weak and fragmented public sector PHC system. The most critical problems contributing to this are the maldistribution of resources (financial, physical and human) between hospitals and the primary care system, and between rural and urban areas. The health sector, therefore, faces the challenge of a complete restructuring and transformation of the national health care delivery system and related institutions. Choices need to be made about which services to cut, which to streamline and where savings can be made. Ways need to be found to use ALL of South Africa's resources optimally. This process of restructuring would be facilitated by the availability of accurate information on resource utilisation in the health sector. This study estimates the difference in the cost of primary diabetes treatment at dayhospitals and a provincial hospital in the Western Cape in 1992/93. Health economics is in its infancy in South Africa and serious data limitations exist. This study is therefore a pioneering effort in many ways. An appropriate methodological framework in which to conduct the costing had to be developed. The South African health sector, health spending arid the cost of primary diabetes treatment at day-hospitals and the provincial hospital are reviewed. Theoretical perspectives of the health care market and the methodologies of cost analysis are discussed. The cost analysis method of study is chosen, and arguments are advanced for its suitability in the South African context. A simple method of calculating the direct costs to obtain the average cost is proposed for the purpose of the study. Direct costs consist of staff costs and other related costs, such as medical supplies, non-medical supplies, building operations, equipment etc. These costs are then used to calculate the average costs per diabetic patient at the day-hospitals and the provincial hospital. The average cost per diabetic patient at day-hospitals amounted to R18.76, while at the provincial hospital the cost was R59.60. https://

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Hearing impairment has been hailed a silent epidemic. Early Hearing Detection and Intervention (EHDI) models of service delivery have therefore been proposed for infants in South Africa so that they may be provided with timely, and appropriate audiological, educational and medical intervention. Neonatal hearing screening in South Africa is currently primarily conducted at Primary Health Care (PHC) clinics. The main objective of the study was to determine whether the neonatal hearing screening services provided at PHC clinics in the City of Johannesburg (CoJ) adhere to the guidelines, norms and standards as outlined by the Integrated National Disability Strategy [INDS] (1997), the Health Professions Council of South Africa [HPCSA] Position Statement (2007) on EHDI and the PHC Package (2002). This was achieved through a non-experimental, descriptive, survey research design. Nurses employed at PHC clinics and children who attended the PHC clinics formed the two participant groups. Data was collected via a self-administered questionnaire, a retrospective data compilation form and observations. Descriptive statistical measures were used to describe the information obtained during data collection. Results indicate that nurses employed within the CoJ PHC clinics do not comply with the proposed neonatal hearing screening practices as outlined in the INDS and the PHC Package. Context specific barriers, including limited knowledge, service delivery gaps, and workload inequities have been identified as contributory factors to the variations and inconsistencies of protocol adherence by PHC nurses. Effective referral systems are important to ensure that these children are provided with appropriate services within the critical period for language development. The optimisation of current governmental hearing screening protocols are thus a feasible, temporary measure until such time that EHDI programmes be mandated at a governmental level.

Background: Symptoms of depression and anxiety are highly prevalent amongst perinatal women in low-resource settings of South Africa, but there is no access to standardised counselling support for these conditions in public health facilities. The aim of this study was to report on the development of a maternal mental health counselling intervention for routine treatment of mild to moderate symptoms of depression and anxiety for primary healthcare in South Africa, as part of the Health Systems Strengthening in sub-Saharan Africa (ASSET) study. Methods: A four-phase study process informed the counselling intervention and training manual designed to train lay health workers. We first conducted a review of manuals from seven counselling interventions for depression and anxiety in low- and middle-income countries and two local health system training programmes to gather information on common counselling components used across maternal mental health and other evidence-based task-sharing interventions. Thereafter, semi-structured interviews were conducted with 20 health workers and 37 pregnant women from four Midwife Obstetric Units in Cape Town to explore mental health views and needs. In the third stage, multi-sector stakeholder engagements further informed the choice of intervention design and service provider. In the final phase, a four-day pre implementation pilot training with community-based health workers refined the counselling content and training material. Results: The manual review identified problem-solving, psychoeducation, basic counselling skills and behavioural activation as common counselling components across interventions. The interviews found that participants mostly identified symptoms of depression and anxiety in behavioural terms and lay health workers and pregnant women demonstrated their understanding through a range of contextual terms. Perceived causes of symptoms related to interpersonal conflict and challenging social circumstances. Stakeholder engagements identified a three session counselling model as most feasible for delivery as part of existing health care practices and community health workers in ward-based outreach teams as the best placed delivery agents. Pilot training of a three-session intervention with community-based health workers resulted in minor adaptations of the counselling assessment method. Conclusion: The study demonstrates how common therapeutic elements can be adapted to a local context and developed into an evidence-based manualised therapeutic programme while remaining sensitive to a health system's needs. While a problem-solving counselling approach, delivered in a structured format, was best suited for training lay health workers, input from health workers and perinatal mothers informed the manualised counselling content. The latter was a critical supplement to align the programme with contextual needs. Stakeholder engagements helped to align the intervention design to health system requirements and guidelines. Structured training practices and ongoing supervision of mental health workers are vital to develop counselling skills over time and to enhance personal support.

Bakgrund: Folksjukdomarna i Sverige består av livsstilsrelaterade åkommor, som hjärt-kärlsjukdomar och diabetes. Genom hälsofrämjande arbete kan uppkomsten av icke smittsamma sjukdomar förebyggas och detta görs främst inom primärvården, där har distriktssköterskorna en stor roll. Syfte: Syftet med studien var att beskriva distriktssköterskors upplevelser av att arbeta hälsofrämjande.  Metod: Studien hade en beskrivande design med kvalitativ ansats. Datainsamlingen genomfördes med semistrukturerade intervjuer utifrån en intervjuguide innefattande öppna frågor.  Totalt deltog tio distriktssköterskor ifrån en region i mellersta Sverige. Analysen genomfördes med kvalitativ innehållsanalys. Huvudresultat: Distriktssköterskorna beskrev det hälsofrämjande arbetet som ett positivt arbete och en intressant utmaning, där kompetensen inom ämnet uttrycktes vara viktig. Det efterfrågades därför förutsättningar för yrkesutveckling i form av utbildning. Förutsättningar på arbetsplatsen som till exempel tid, personal eller samarbete med andra professioner styrde hur mycket preventivt arbete som kunde genomföras. Patientens motivation och önskan att vara delaktig i sin vård, var förutsättningar som också styrde det hälsofrämjande arbetet. Att avsätta tid för organisering av arbete, fokus på hälsofrämjande, skapa enighet i arbetsgruppen och gemensamma mätbara mål på arbetsplatsen, var förslag på åtgärder som kan förbättra det hälsofrämjande arbetet. Slutsats: Distriktssköterskorna upplevde det hälsofrämjande arbetet som en spännande, intressant utmaning och hade en vilja att arbeta med det.  Dock var det förutsättningar på arbetsplatsen, hos patienten samt från ledningen som styrde hur mycket distriktssköterskorna kunde arbeta hälsofrämjande. / Background: Non-communicable diseases in Sweden consists of lifestyle-related disorders, such as cardiovascular disease and diabetes. Through health promotion non-communicable diseases can be prevented and this is done primarily in the primary health care, where the district nurses play a major role. Purpose: The purpose of this study was to describe district nurses ´experience of health promotion in primary health care. Method: The study had a qualitative approach with descriptive design. The data collection implemented with semi-structured interviews based on an interview guide which included open questions, with ten district nurses who agreed to participate. The analysis was done with qualitative content analysis. Main findings: The district nurses described the health promotion as positive and an interesting challenge, where the expertise in the subject was expressed as important. Therefore they requested conditions for professional development thru education. Conditions in the workplace such as time, staff or collaboration with other professions controlled how much preventively work could be implemented. The patient´s motivation and desire to be involved in their care was conditions of the patient who also controlled health promotion. Several actions where proposed that could improve the preventively work, such as more time to organize the work, more focus on preventively work, unity in the work group and a common measurable goal in the workplace. Conclusion: The district nurses had a desire to do health promotion work and experienced the work to be an exciting challenge, but the conditions controlled their work.

What is the Primary Care Behavioral Health (PCBH) model of service delivery? Clinician innovators, administrators, and researchers have continued to refine the answer to this question. In the same way a recipe for mac n cheese provides the resources needed (i.e., ingredients), processes to make the dish, and expected outcomes (e.g., number of servings), a comprehensive operational definition for PCBH is needed to help improve the rigor of research being conducted. This recipe can also help clinicians/administrators identify a basic recipe for PCBH that standardizes the necessary components and amounts to achieve the expected outcomes. In this editorial, we provide a comprehensive operational recipe for PCBH based on current research. We are calling people to assist us by (a) utilizing the recipe to help improve the reporting and rigor of PCBH research and (b) applying the proposed operational definitions and targets within the recipe to help us refine and validate them. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

This policy paper reviews the history, use and significance of telehealth in primary care. The emergence of telehealth as a primary strategy to continue to deliver value based, timely primary care during COVID-19 is discussed with recommendations for future applications, payment and preparation of providers to continue to provide quality care of clients in the future using telehealth.

When people are healthy, they are able to accomplish with relative ease what they set out to do, such as going to work, traveling, meeting with friends, and taking care of their personal necessities. However, once chronic illness becomes a factor in a person’s life, he or she is faced with limitations in the ability to perform daily activities, take care of health needs and participate in life activities. More effort is required for everyday activities, leading to abandonment of previously enjoyed routines and further declines in health and quality of life (Erlandsson, 2013a). In response to the complex, dynamic, and often unpredictable care requirements of individuals with one or more chronic conditions, newer primary care delivery models were developed to improve health management and reduce costs (Sevick et al., 2007). The expectation is that these interprofessional team–based models are the best way to address the needs of persons with multiple chronic conditions (Piette et al., 2011). However those charged with providing primary care based on these models have been unable to expand beyond disease-based episodic approaches and healthcare delivery is thus perceived as inadequate in fully serving this growing population (Fortin et al., 2013). The author developed and implemented occupation-based occupational therapy (OT) services and the VA Everyday Matters workshop to demonstrate that OT should be included as a vital component of a primary care effort aimed at meeting the complex needs of Veterans with chronic conditions. Health behavior theory and occupational therapy models informed the role of OT in primary care and the development of the workshop. The use of an occupation-based approach represents an innovative change in how health promotion is conceptualized and delivered in the traditional primary care setting. The immediate and long-term outcomes of this project will have important implications for occupational therapy practice and will contribute to a growing body of knowledge about the health promoting effects of occupation. Findings from the program evaluation will be disseminated throughout the VA and will inform the continued development of innovative ways occupational therapy and primary care can partner to optimize function and quality of life for at-risk Veteran populations.

Introduktion: Hälsofrämjande arbete är en central del i sjuksköterskans och distriktssköterskans arbete, och ska bedrivas i primärvården enligt svensk lag. Detta är en viktig åtgärd för att minska förekomsten av och dödsfallen bland icke-smittsamma sjukdomar, som idag står för ca 70% av dödsfallen i världen. Genom att studera sjuksköterskors beskrivning av möjligheter och hinder med hälsofrämjande arbete kan förståelsen öka för arbetet.  Syfte: Undersöka hur sjuksköterskor beskriver möjligheter och hinder för att lyckas med hälsofrämjande arbete i primärvården. Metod: En allmän litteraturöversikt med 15 kvalitativa studier genomfördes. Databaserna som användes var PubMed och Cinahl. Dataanalysen var en induktiv integrerad innehållsanalys.  Resultat: I resultatet framkom att det finns flera faktorer som påverkar möjligheten att lyckas med hälsofrämjande arbete. Fyra kategorier bildades; Faktorer hos sjuksköterskan, faktorer hos patienten, faktorer i patientmötet och faktorer i organisationen. Hos sjuksköterskan belystes kunskap och erfarenhet tillsammans med ett holistiskt och personcentrerat förhållningssätt som faktorer som underlättar hälsofrämjande arbete. Hos patienten var dennes egna motivation den viktigaste faktorn för att lyckas, men patientens kunskap och socioekonomi kunde inverka både positivt och negativt. En god relation mellan sjuksköterskan och patienten var grunden i patientmötet. Organisationens prioriteringar och attityder kring hälsofrämjande arbete var en viktig faktor för att lyckas.  Slutsats: För att lyckas med hälsofrämjande arbete behöver flera faktorer samverka. Genom att minska hindren och öka möjligheterna kan bättre och mer långsiktiga resultat för patienten uppnås. / Introduction: Health promotion is a core essence of the nurse and district nurse practice, and should be provided by primary health care according to Swedish law. This is an important measure to reduce the prevalence and deaths caused by non-communicable diseases, which today is responsible for approximately 70% of all deaths globally. By studying nurses’ descriptions of facilitators and barriers for health promotion, the understanding of the work can increase. Aim: Study how nurses’ describe facilitators and barriers to succeed with health promotion in primary health care.   Method: A general literature review with 15 qualitative studies was conducted. The databases used were PubMed and Cinahl. The data analysis was an inductive integrated content analysis. Results: There are several factors that affect the possibility to succeed with health promotion work. Four categories were formed; Factors in the nurse, factors in the patient, factors in the patient-encounter and factors in the organization. For the nurse, knowledge and experience together with a holistic and person-centered approach were highlighted as factors that facilitate health promotion work. The patient's own motivation was the most important factor for success, but the patient's knowledge and socioeconomics could have both positive and negative impact. A good nurse-patient relationship was the basis of the patient encounter. The organization's priorities and attitudes regarding health promotion were an important factor for success. Conclusion: In order to succeed in health promotion, several factors need to work together. By reducing barriers and increasing facilitators, the patient's results could improve and become more sustainable.