INTRODUCTION: Non-communicable diseases (NCDs) burden has increased significantly over the past decade in Saudi Arabia (SA). Disparities of NCDs disease prevalence have been documented; however, little is known regarding inequities in NCDs health services access and delivery especially at the primary health care (PHC) level. Moreover, equity considerations have not explicitly been part of allocative financial decision-making criteria. The goal of this study is to assess equity-related challenges in accessing NCDs services as well as the current NCDs priority setting and financial resources allocation process to support the ongoing health system transformation efforts. METHODS: This study used a mixed methods approach. The quantitative data was obtained from existing secondary data of 10,000 households’ surveys, The Kingdom of SA World Health Survey, 2019. The primary collected qualitative data consist of 33 in-depth interviews (IDIs) with public officials from national and regional level using an interview guide supported by documents review. A multiple logistic regression and thematic analysis were used for the analysis. RESULTS: More than 35% of people with diagnosed diabetes, hypertension or dyslipidemia have an unmet need of primary care services. Only 20% of surveyed women had a cervical cancer screening during their last pelvic exam while only 18% of eligible women ever had a mammogram. Significant factors affecting primary care services utilization were region of residence, population density, wealth, income and education. Findings from the interviews revealed that NCDs and PHC are top priorities of the Saudi health reform with strong political commitment and major investments. However, there is no clear strategic direction to improve NCDs services given the highly centralized financial system with suboptimal resources allocation towards PHC and where increasing efficiency focuses mainly on higher level care. Governance-related challenges include accountability and power struggle, partly due to financial and human resources variations across the region. DISCUSSION: Improving budget formulation for primary care and NCDs programs, and harmonizing NCDs programs funding across sectors apart from the health sector while defining what equity and allocative efficiency mean for the Saudi health system transformation are priorities to achieve the health system transformation goals. / 2025-12-11T00:00:00Z

Introduktion: Telefonrådgivning är en svår uppgift som ställer höga krav på sjuksköterskan. Det krävs att sjuksköterskan har bred kunskap inom många olika områden, samtidigt som en bedömning ska göras utan att sjuksköterskan kan se patienten. Det är en viktig och krävande uppgift. Därför är det viktigt att belysa ämnet. Syfte: Syftet var att belysa sjuksköterskors erfarenheter av telefonrådgivning inom primärvård samt vad sjuksköterskorna upplever påverkar dem i det arbetet. Metod: För att utforska studiens syfte utfördes en systematisk litteraturstudie enligt Polit och Becks niostegsmodell, med en kvalitativ innehållsanalys enligt Graneheim och Lundman. Studiens resultat baserades på nio artiklar från databaserna CINAHL och PubMed samt två artiklar från en manuell sökning. Resultat: Tre kategorier framkom i analysen. Dessa var: Sjuksköterskans tillvägagångssätt, Yttre faktorer som påverkar sjuksköterskan och Sjuksköterskans individuella förutsättningar. Slutsatser: Sjuksköterskan har en komplex roll i telefonrådgivningen. Sjuksköterskan strävar efter att arbeta personcentrerat i samtalen. Den tidsgräns som finns är stressande och ger minskad möjlighet till återhämtning. Det är utmanande för sjuksköterskan att förlita sig på den verbala kommunikationen och att göra en bedömning av patienten över telefon. Kollegialt stöd, arbetslivserfarenhet och utbildning gör arbetet enklare. Tydlig kommunikation mellan sjuksköterska och patient är a och o. En god kommunikation leder till ökad följsamhet och patientsäkerhet. Det ger möjlighet till ett gott samtal där kommunikationen flyter och båda parter är nöjda när luren läggs på.

Primary care within the United States’ health care system is evolving to address increases in chronic conditions across the lifespan that impact individuals’ daily lives, and the health care system’s performance and cost. Even as interprofessional primary care teams aim to manage a large majority of health needs over time, these teams often lack the skilled professionals necessary to address function in daily life. Occupational therapy’s distinct value as experts in evaluation and intervention for health-related occupational development, adaptation, prevention and management can address this problem. However, continued education and additional tools are necessary in order for occupational therapists to increase their knowledge of the profession’s role in primary care, increase self-efficacy in promoting occupational therapy to stakeholders, and increase self-efficacy to utilize resources for research and establishing occupational therapy in primary care settings. The proposed online course "Occupational Therapy in Primary Care: What, Why, Where, & How?" is specifically targeted to occupational therapists to addresses these outcomes. Theoretical and historical evaluation of occupational therapy in primary care in the United States and Canada supports understanding the problem and mechanisms that can help navigate efforts to include occupational therapy in primary care. Diffusion of Innovations and Adult Learning Theory guide the course’s two-phases of development and dissemination. This project is a timely contribution to the emerging area of occupational therapy in primary care that supports the Institute for Health Care Improvements’ (IHI) Triple Aim to improve the individual experience of care, health of populations and reduce per capita cost of care.

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No / This study explores GP tutor views of a nationally derived list of quality criteria for undergraduate and postgraduate practice-based teaching. Whilst these published criteria provided a means of benchmarking locally, an evaluation of utility in practice required further exploration. This educational evaluation was conducted within a West Yorkshire locality as a means of supporting their practice-based primary care education. A survey approach using an online Likert scaled questionnaire was distributed to all GP tutors with an additional opportunity for free text qualitative comments. Data were analysed using an online reporting package for survey results (MarketSight) and thematic analysis of qualitative data. Key findings were that in general all the criteria were rated having a high level of importance with 83% of GPs claiming they would find such a list important in directing their learning and teaching approach. The opinions on out-of-hours experiences for medical students were also interesting as they differed greatly. These findings will be of interest to those involved in the organisation and delivery of medical education within primary care as the list of criteria could act as a structural guide for directing medical student teaching, learning and its quality assurance. Implications for further research include the utility of core criteria and the exploration of out-of-hours experience for medical student education.

Background: Type 2 diabetes is an increasingly prevalent public health issue characterized by a progressive disease course. It is attributed to various factors, including lifestyle, reduced physical activity, and genetics. Enhanced knowledge among primary care nurses can enable patients to implement lifestyle changes effectively. Aim: The purpose was to describe nurses’ experiences of supporting patients with type 2 diabetes to selfcare in primary health care settings. Method: This study employs a general literature review methodology with qualitative approaches, drawing on 10 scientific articles. Results: The analysis identified two main categories: communication as well as knowledge and motivation. These categories were crucial from the nurse´s side to achieve self-care in the patient. Different experiences emerged from nurse´s side to achieve motivation and communication. Conclusion: Type 2 diabetes is a growing public health concern. A significant barrier to effective management is the lack of knowledge among both nurses and patients. There is a critical need for competent nurses in primary care to motivate patients towards lifestyle modification and self-care.

Yes / Background Recently, primary care in the United Kingdom has undergone substantial changes in skill mix. Non-medical prescribing was introduced to improve patient access to medicines, make better use of different health practitioners’ skills and increase patient choice. There is little evidence about value-based patient preferences for ‘prescribing nurse’ in a general practice setting. Objective To quantify value-based patient preferences for the profession of prescriber and other factors that influence choice of consultation for managing a minor illness. Design Discrete choice experiment patient survey. Setting and participants Five general practices in England with non-medical prescribing services, questionnaires completed by 451 patients. Main outcome measure Stated choice of consultation. Main results There was a strong general preference for consulting ‘own doctor’ for minor illness. However, a consultation with a nurse prescriber with positive patient-focused attributes can be more acceptable to patients than a consultation provided by a doctor. Attributes ‘professional’s attention to patients’ views’ and extent of ‘help offered’ were pivotal. Past experience influenced preference. Discussion and conclusion Respondents demonstrated valid preferences. Preferences for consulting a doctor remained strong, but many were happy to consult with a nurse if other aspects of the consultation were improved. Findings show who to consult is not the only valued factor in choice of consultation for minor illness. The ‘prescribing nurse’ role has potential to offer consultation styles that patients value. Within the study’s limitations, these findings can inform delivery of primary care to enhance patient experience and substitute appropriate nurse prescribing consultations for medical prescribing consultations. / Department of Health, Project 016/0108. NIHR, CDF/01/2008/009.

A quantitative, descriptive, explorative design was used to evaluate a decentralised primary health care training programme at a training unit in the Limpopo Province. The study sought to determine to what extent the newly qualified diplomates were able to manage patients appropriately when faced with the realities, such as the shortage of personnel, large numbers of patients, shortage of resources and time constraints in the real situation without the support and guidance from medical practitioners and senior nursing personnel. Data were collected by observing the diplomates as they managed patients with hypertension by making use of checklists. The diplomates were also interviewed by making use of an in interview schedule. The major inferences drawn from this study was that these diplomates were competent in the management of these patients and were satisfied with their abilities and training. / Health Studies / M. A. (Health Studies)

Since 1994 a number of health reforms took place in furthering democracy. These changes included the decentralisation of Primary Health Care Services. This study is a phenomenological research that chronicles the Primary Health Care decentralisation experiences in the Bophirima District of the North-West Province. Using a descriptive phenomenological orientation, the purpose of this study was to describe the experiences of participants associated with decentralisation in the Bophirima District. Also, to illustrate how the participants perceive these experiences in relation to Primary Health Care services. Furthermore, to provide scientific evidence regarding factors related to the decentralisation of PHC services in the Bophirima District. These and other issues remain of paramount importance given the current state of health care in the South Africa. This study took place in the outskirts of the semi-rural area of Bophirima and Central District in the North-West Province. The investigation followed qualitative research design that was descriptive, exploratory, contextual and phenomenological in nature. The sampling procedure involved non-probability purposive, sampling technique with a sample size of five participants. Data was collected by using an unstructured interview technique. The modified Giorgi method of analysis was used for qualitative data analysis. These are contained in Burns and Grove (2001:596) and Polit and Beck (2004:394) are fully explicated in Chapter Four. Guba model (in Babbie & Mouton, 2001:180) was utilised to ensure the trustworthiness of the study. Ethical requirements were considered throughout and these are reflected in chapter four of the thesis.Three forms of decentralisation: deconcentration, delegation and devolution were identified in the findings. The investigation further indicated that the integration of primary health care services was also underway at the time of decentralisation. This integration triggered different psychological and emotional states amongst research participants. Most importantly, the research revealed that the interest of leadership across three spheres of government played a key role in the decentralisation of PHCs and integration of PHCs, while highlighting the importance of community participation in health service delivery (CP). In conclusion, the decentralisation process was generally perceived as empowering although, nationally, leadership needs to be strengthened to support provinces and districts regarding major policy issues such decentralisation. Key recommendations were made and further research was suggested. / Health Studies / D. Litt. et Phil. (Health Studies)

Justificativa: As Internações por Condições Sensíveis à Atenção Básica são um conjunto de problemas de saúde, para os quais o acesso aos serviços de AB e ações efetivas poderiam reduzir a ocorrência destas internações, tornando-as um indicador de resultado para avaliação da qualidade e do acesso nesse nível de atenção. Assim, analisou-se o indicador de ICSAB, buscando fatores associados à sua ocorrência, a fim de avaliar a sua capacidade de verificar a resolutividade da atenção básica. Métodos: Realizou-se uma análise exploratória descritiva do ICSAB nas sete macrorregiões de saúde e 30 regiões de saúde do Rio Grande do Sul, com base na Cobertura de Saúde da Família, seguida de uma revisão da produção indexada sobre ICSAB, com o objetivo de verificar quais fatores estão correlacionados com o desfecho ICSAB. Por fim desenvolveu-se um estudo ecológico com medidas agregadas, testando o grau de correlação linear entre as variáveis selecionadas a partir da revisão, utilizando o coeficiente de correlação de Spearman Resultados: Foram encontrados na literatura diversos fatores correlacionados à ocorrência de ICSAB, tanto no âmbito da disponibilidade de serviços de saúde, como na perspectiva socioeconômica. Em relação a realidade do RS, encontrou-se correlação de ICSAB com quantidade de leitos (p=0.002), Proporção de pessoas com planos de saúde (p=0,001), IDH (p=0.004) e analfabetismo (p=0.001) e população menor de quatro anos (p=0,001). Considerações: O indicador ICSAB cumpre seu objetivo de tornar comparável de forma sintética a situação da Atenção Básica nas diversas possibilidades de recortes territoriais. Contudo, as variáveis que interferem nesse desfecho são diversas, operando de maneiras diferentes em cada contexto e necessitando de maior aprofundamento. Enquanto subsídio para políticas e ações de qualificação da Atenção Básica, a mudança desse indicador só ocorrerá quando esse dado servir como dispositivo inicial para entender processos complexos e locais, que ocorrerão através de processos de educação permanente. / Background: Hospitalizations for Sensitive Conditions to Primary Health Care (HSCPHC) are a group of health problems, for which access to Primary Health Care services and effective actions could reduce the occurrence of these hospitalizations, making them an outcome indicator for quality and access to this level of attention. Thus, the HSCPHC indicator was analyzed, looking for factors associated with its occurrence, in order to evaluate its capacity to verify the resolution of basic care. Methods: A descriptive exploratory analysis of the HSCPHC was carried out in the seven macro-regions of health and 30 health regions of Rio Grande do Sul, based on the Family Health Coverage, followed by a review of the indexed production on HSCBC, with the objective of verify which factors are correlated with the HSCPHC outcome. Finally, an ecological study with aggregate measures was developed, testing the degree of linear correlation between the variables selected from the review using Spearman's correlation coefficient Results: A number of factors correlated with the occurrence of HSCPHC were found in the literature, both in terms of the availability of health services and in the socioeconomic perspective. In relation to Rio Grande do Sul reality, we found a correlation of HSCBC with number of hospital beds (p = 0.002), Proportion of people with health plans (p = 0.001), HDI (p = 0.004) and illiteracy (p = 0.001) and population younger than four years (p = 0.001). Considerations: The HSCPHC indicator fulfills its objective of making the situation of Primary Health Care in the various possibilities of territorial cuts comparable in a synthetic way. However, the variables that interfere in this outcome are diverse, operating differently in each context and requiring further study. As a subsidy for policies and actions to qualify Primary Health Care, the change in this indicator will only occur when this data serves as an initial device to understand complex and local processes that will occur through processes of permanent education.