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1.
N Engl J Med ; 390(13): 1196-1206, 2024 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-38598574

RESUMO

BACKGROUND: Despite the availability of effective therapies for patients with chronic kidney disease, type 2 diabetes, and hypertension (the kidney-dysfunction triad), the results of large-scale trials examining the implementation of guideline-directed therapy to reduce the risk of death and complications in this population are lacking. METHODS: In this open-label, cluster-randomized trial, we assigned 11,182 patients with the kidney-dysfunction triad who were being treated at 141 primary care clinics either to receive an intervention that used a personalized algorithm (based on the patient's electronic health record [EHR]) to identify patients and practice facilitators to assist providers in delivering guideline-based interventions or to receive usual care. The primary outcome was hospitalization for any cause at 1 year. Secondary outcomes included emergency department visits, readmissions, cardiovascular events, dialysis, and death. RESULTS: We assigned 71 practices (enrolling 5690 patients) to the intervention group and 70 practices (enrolling 5492 patients) to the usual-care group. The hospitalization rate at 1 year was 20.7% (95% confidence interval [CI], 19.7 to 21.8) in the intervention group and 21.1% (95% CI, 20.1 to 22.2) in the usual-care group (between-group difference, 0.4 percentage points; P = 0.58). The risks of emergency department visits, readmissions, cardiovascular events, dialysis, or death from any cause were similar in the two groups. The risk of adverse events was also similar in the trial groups, except for acute kidney injury, which was observed in more patients in the intervention group (12.7% vs. 11.3%). CONCLUSIONS: In this pragmatic trial involving patients with the triad of chronic kidney disease, type 2 diabetes, and hypertension, the use of an EHR-based algorithm and practice facilitators embedded in primary care clinics did not translate into reduced hospitalization at 1 year. (Funded by the National Institutes of Health and others; ICD-Pieces ClinicalTrials.gov number, NCT02587936.).


Assuntos
Diabetes Mellitus Tipo 2 , Hospitalização , Hipertensão , Insuficiência Renal Crônica , Humanos , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Hospitalização/estatística & dados numéricos , Hipertensão/epidemiologia , Hipertensão/terapia , Diálise Renal , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Medicina de Precisão , Registros Eletrônicos de Saúde , Algoritmos , Atenção Primária à Saúde/estatística & dados numéricos
3.
BMC Health Serv Res ; 24(1): 517, 2024 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-38658925

RESUMO

OBJECTIVE: This study aimed to assess the service quality (SQ) for Type 2 diabetes mellitus (T2DM) and hypertension in primary healthcare settings from the perspective of service users in Iran. METHODS: The Cross-sectional study was conducted from January to March 2020 in urban and rural public health centers in the East Azerbaijan province of Iran. A total of 561 individuals aged 18 or above with either or both conditions of T2DM and hypertension were eligible to participate in the study. The study employed a two-step stratified sampling method in East Azerbaijan province, Iran. A validated questionnaire assessed SQ. Data were analyzed using One-way ANOVA and multiple linear regression statistical models in STATA-17. RESULTS: Among the 561 individuals who participated in the study 176 (31.3%) were individuals with hypertension, 165 (29.4%) with T2DM, and 220 (39.2%) with both hypertension and T2DM mutually. The participants' anthropometric indicators and biochemical characteristics showed that the mean Fasting Blood Glucose (FBG) in individuals with T2DM was 174.4 (Standard deviation (SD) = 73.57) in patients with T2DM without hypertension and 159.4 (SD = 65.46) in patients with both T2DM and hypertension. The total SQ scores were 82.37 (SD = 12.19), 82.48 (SD = 12.45), and 81.69 (SD = 11.75) for hypertension, T2DM, and both conditions, respectively. Among people with hypertension and without diabetes, those who had specific service providers had higher SQ scores (b = 7.03; p = 0.001) compared to their peers who did not have specific service providers. Those who resided in rural areas had lower SQ scores (b = -6.07; p = 0.020) compared to their counterparts in urban areas. In the group of patients with T2DM and without hypertension, those who were living in non-metropolitan cities reported greater SQ scores compared to patients in metropolitan areas (b = 5.09; p = 0.038). Additionally, a one-point increase in self-management total score was related with a 0.13-point decrease in SQ score (P = 0.018). In the group of people with both hypertension and T2DM, those who had specific service providers had higher SQ scores (b = 8.32; p < 0.001) compared to the group without specific service providers. CONCLUSION: Study reveals gaps in T2DM and hypertension care quality despite routine check-ups. Higher SQ correlates with better self-care. Improving service quality in primary healthcare settings necessitates a comprehensive approach that prioritizes patient empowerment, continuity of care, and equitable access to services, particularly for vulnerable populations in rural areas.


Assuntos
Diabetes Mellitus Tipo 2 , Hipertensão , Atenção Primária à Saúde , Qualidade da Assistência à Saúde , Humanos , Diabetes Mellitus Tipo 2/terapia , Hipertensão/terapia , Hipertensão/epidemiologia , Irã (Geográfico) , Estudos Transversais , Masculino , Feminino , Pessoa de Meia-Idade , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Adulto , Idoso , Inquéritos e Questionários , Serviços de Saúde Rural/normas , Serviços de Saúde Rural/estatística & dados numéricos , Serviços Urbanos de Saúde/normas , Serviços Urbanos de Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos
4.
Front Public Health ; 12: 1384327, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38660363

RESUMO

Background: Despite the established effectiveness of the BNT162b2 Vaccine, the novel technology demands careful safety monitoring. While global studies have explored its safety, local data remains limited and exhibits some variability. This study investigated short-term side effects among BNT162b2 vaccinated individuals in Qatar. Methods: A retrospective analysis was conducted using data extracted from the electronic health records of individuals aged 18 or older across 8 primary health centers who received either the first or second dose of the BNT162b2 vaccine during the period from December 23, 2020, to April 24, 2021. The proportions of individuals experiencing short-term side effects after each dose were calculated. Logistic regression and log binomial regression analyses were used to explore associations with the side effects. Results: Among 7,764 participants, 5,489 received the first dose and 2,275 the second, with similar demographics between the groups. After the first dose, 5.5% reported at least one local side effect, compared to 3.9% after the second, with a 1.4 times higher incidence after the first dose (RR 1.4, 95% CI 1.14-1.75) compared to the second. Systemic side effects after the second dose were 2.6 times more common than after the first (RR 2.6, 95% CI 2.15-3.14). Gender, nationality, history of prior COVID-19 infection, and obesity were significantly associated with side effects after the first dose, while age, gender, and nationality, were significant factors after the second dose. Conclusion: The rates of side effects following the BNT162b2 vaccine in Qatar were relatively low, with age, gender, nationality, previous infection, and obesity identified as significant predictors. These results emphasize the need for tailored vaccination strategies and contributes valuable insights for evidence-based decision-making in ongoing and future vaccination campaigns.


Assuntos
Vacina BNT162 , COVID-19 , Atenção Primária à Saúde , Humanos , Catar , Estudos Retrospectivos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , COVID-19/prevenção & controle , Adolescente , Adulto Jovem , Idoso , Vacinas contra COVID-19/efeitos adversos , Vacinas contra COVID-19/administração & dosagem , SARS-CoV-2
5.
BMJ Open ; 14(4): e076441, 2024 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-38658014

RESUMO

INTRODUCTION: Diabetic foot ulcers are feared complications of diabetes mellitus (DM), requiring extensive treatment and hospital admissions, ultimately leading to amputation and increased mortality. Different factors contribute to the development of foot ulcers and related complications. Onychomycosis, being more prevalent in patients with diabetes, could be an important risk factor for developing ulcers and related infections. However, the association between onychomycosis and diabetic complications has not been well studied in primary care. RESEARCH DESIGN AND METHODS: To determine the impact of onychomycosis on ulcer development and related complications in patients with diabetes in primary care, a longitudinal cohort study was carried out using routine care data from the Extramural Leiden University Medical Center Academic Network. Survival analyses were performed through Cox proportional hazards models with time-dependent covariates. RESULTS: Data from 48 212 patients with a mean age of 58 at diagnosis of DM, predominantly type 2 (87.8%), were analysed over a median follow-up of 10.3 years. 5.7% of patients developed an ulcer. Onychomycosis significantly increased the risk of ulcer development (HR 1.37, 95% CI 1.13 to 1.66), not affected by antimycotic treatment, nor after adjusting for confounders (HR 1.23, 95% CI 1.01 to 1.49). The same was found for surgical interventions (HR 1.54, 95% CI 1.35 to 1.75) and skin infections (HR 1.48, CI 95% 1.28 to 1.72), again not affected by treatment and significant after adjusting for confounders (HR 1.32, 95% CI 1.16 to 1.51 and HR 1.27, 95% CI 1.10 to 1.48, respectively). CONCLUSIONS: Onychomycosis significantly increased the risk of ulcer development in patients with DM in primary care, independently of other risk factors. In addition, onychomycosis increased the risk of surgeries and infectious complications. These results underscore the importance of giving sufficient attention to onychomycosis in primary care and corresponding guidelines. Early identification of onychomycosis during screening and routine care provides a good opportunity for timely recognition of increased ulcer risk.


Assuntos
Pé Diabético , Onicomicose , Humanos , Onicomicose/epidemiologia , Onicomicose/complicações , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Longitudinais , Países Baixos/epidemiologia , Pé Diabético/epidemiologia , Idoso , Fatores de Risco , Medicina Geral/estatística & dados numéricos , Diabetes Mellitus Tipo 2/complicações , Modelos de Riscos Proporcionais , Adulto , Atenção Primária à Saúde/estatística & dados numéricos
6.
JAMA ; 331(11): 959-971, 2024 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-38502070

RESUMO

Importance: Child maltreatment is associated with serious negative physical, psychological, and behavioral consequences. Objective: To review the evidence on primary care-feasible or referable interventions to prevent child maltreatment to inform the US Preventive Services Task Force. Data Sources: PubMed, Cochrane Library, and trial registries through February 2, 2023; references, experts, and surveillance through December 6, 2023. Study Selection: English-language, randomized clinical trials of youth through age 18 years (or their caregivers) with no known exposure or signs or symptoms of current or past maltreatment. Data Extraction and Synthesis: Two reviewers assessed titles/abstracts, full-text articles, and study quality, and extracted data; when at least 3 similar studies were available, meta-analyses were conducted. Main Outcomes and Measures: Directly measured reports of child abuse or neglect (reports to Child Protective Services or removal of the child from the home); proxy measures of abuse or neglect (injury, visits to the emergency department, hospitalization); behavioral, developmental, emotional, mental, or physical health and well-being; mortality; harms. Results: Twenty-five trials (N = 14 355 participants) were included; 23 included home visits. Evidence from 11 studies (5311 participants) indicated no differences in likelihood of reports to Child Protective Services within 1 year of intervention completion (pooled odds ratio, 1.03 [95% CI, 0.84-1.27]). Five studies (3336 participants) found no differences in removal of the child from the home within 1 to 3 years of follow-up (pooled risk ratio, 1.06 [95% CI, 0.37-2.99]). The evidence suggested no benefit for emergency department visits in the short term (<2 years) and hospitalizations. The evidence was inconclusive for all other outcomes because of the limited number of trials on each outcome and imprecise results. Among 2 trials reporting harms, neither reported statistically significant differences. Contextual evidence indicated (1) widely varying practices when screening, identifying, and reporting child maltreatment to Child Protective Services, including variations by race or ethnicity; (2) widely varying accuracy of screening instruments; and (3) evidence that child maltreatment interventions may be associated with improvements in some social determinants of health. Conclusion and Relevance: The evidence base on interventions feasible in or referable from primary care settings to prevent child maltreatment suggested no benefit or insufficient evidence for direct or proxy measures of child maltreatment. Little information was available about possible harms. Contextual evidence pointed to the potential for bias or inaccuracy in screening, identification, and reporting of child maltreatment but also highlighted the importance of addressing social determinants when intervening to prevent child maltreatment.


Assuntos
Maus-Tratos Infantis , Atenção Primária à Saúde , Determinantes Sociais da Saúde , Adolescente , Criança , Humanos , Diretivas Antecipadas , Comitês Consultivos , Maus-Tratos Infantis/prevenção & controle , Maus-Tratos Infantis/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Estados Unidos/epidemiologia , Serviços de Proteção Infantil/estatística & dados numéricos
7.
Nurs Res ; 73(3): 248-254, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38329959

RESUMO

BACKGROUND: Co-management encompasses the dyadic process between two healthcare providers. The Provider Co-Management Index (PCMI) was initially developed as a 20-item instrument across three theory-informed subscales. OBJECTIVE: This study aimed to establish construct validity of the PCMI with a sample of primary care providers through exploratory and confirmatory factor analyses. METHODS: We conducted a cross-sectional survey of primary care physicians, nurse practitioners, and physician assistants randomly selected from the IQVIA database across New York State. Mail surveys were used to acquire a minimum of 300 responses for split sample factor analyses. The first subsample (derivation sample) was used to explore factorial structure by conducting an exploratory factor analysis. A second (validation) sample was used to confirm the emerged factorial structure using confirmatory factor analysis. We performed iterative analysis and calculated good fit indices to determine the best-fit model. RESULTS: There were 333 responses included in the analysis. Cronbach's alpha was high for a three-item per dimension scale within a one-factor model. The instrument was named PCMI-9 to indicate the shorter version length. DISCUSSION: This study established the construct validity of an instrument that scales the co-management of patients by two providers. The final instrument includes nine items on a single factor using a 4-point, Likert-type scale. Additional research is needed to establish discriminant validity.


Assuntos
Atenção Primária à Saúde , Psicometria , Humanos , Estudos Transversais , Masculino , Feminino , Reprodutibilidade dos Testes , Inquéritos e Questionários/normas , Adulto , New York , Pessoa de Meia-Idade , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Psicometria/instrumentação , Análise Fatorial , Profissionais de Enfermagem/estatística & dados numéricos , Profissionais de Enfermagem/normas , Médicos de Atenção Primária/estatística & dados numéricos , Médicos de Atenção Primária/normas , Médicos de Atenção Primária/psicologia , Pessoal de Saúde/estatística & dados numéricos , Pessoal de Saúde/psicologia
8.
Am J Prev Med ; 66(5): 770-779, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38101464

RESUMO

INTRODUCTION: Federally Qualified Health Centers may increase access to HIV prevention, care, and treatment for at-risk populations. METHODS: A pooled cross section of ZIP Code Tabulation Areas from cites in the U.S. South with high HIV diagnoses were used to examine Federally Qualified Health Center density and indicators of HIV epidemic control. The explanatory variable was Federally Qualified Health Center density-number of Federally Qualified Health Centers in a ZIP Code Tabulation Areas' Primary Care Service Area per low-income population-high versus medium/low (2019). Outcomes were 5-year (2015-2019 or 2014-2018) (1) number of new HIV diagnoses, (2) percentage late diagnosis, (3) percentage linked to care, and (4) percentage virally suppressed, which was assessed over 1 year (2018 or 2019). Multiple linear regression was used to examine the relationship, including ZIP Code Tabulation Area-level sociodemographic and city-level HIV funding variables, with state-fixed effects, and data analysis was completed in 2022-2023. Sensitivity analyses included (1) examining ZIP Code Tabulation Areas with fewer non-Federally Qualified Health Center primary care providers, (2) controlling for county-level primary care provider density, (3) excluding the highest HIV prevalence ZIP Code Tabulation Areas, and (4) excluding Florida ZIP Code Tabulation Areas. RESULTS: High-density ZIP Code Tabulation Areas had a lower percentage of late diagnosis and virally suppressed, a higher percentage linked to care, and no differences in new HIV diagnoses (p<0.05). In adjusted analysis, high density was associated with a greater number of new diagnoses (number or percentage=5.65; 95% CI=2.81, 8.49), lower percentage of late diagnosis (-3.71%; 95% CI= -5.99, -1.42), higher percentage linked to care (2.13%; 95% CI=0.20, 4.06), and higher percentage virally suppressed (1.87%; 95% CI=0.53, 2.74) than medium/low density. CONCLUSIONS: Results suggest that access to Federally Qualified Health Centers may benefit community-level HIV epidemic indicators.


Assuntos
Infecções por HIV , Acesso aos Serviços de Saúde , Humanos , Infecções por HIV/epidemiologia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Estudos Transversais , Pobreza/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estados Unidos/epidemiologia , Sudeste dos Estados Unidos/epidemiologia , Diagnóstico Tardio/estatística & dados numéricos , Feminino , Masculino
9.
JAMA ; 330(14): 1348-1358, 2023 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-37815566

RESUMO

Importance: Realizing the benefits of cancer screening requires testing of eligible individuals and processes to ensure follow-up of abnormal results. Objective: To test interventions to improve timely follow-up of overdue abnormal breast, cervical, colorectal, and lung cancer screening results. Design, Setting, and Participants: Pragmatic, cluster randomized clinical trial conducted at 44 primary care practices within 3 health networks in the US enrolling patients with at least 1 abnormal cancer screening test result not yet followed up between August 24, 2020, and December 13, 2021. Intervention: Automated algorithms developed using data from electronic health records (EHRs) recommended follow-up actions and times for abnormal screening results. Primary care practices were randomized in a 1:1:1:1 ratio to (1) usual care, (2) EHR reminders, (3) EHR reminders and outreach (a patient letter was sent at week 2 and a phone call at week 4), or (4) EHR reminders, outreach, and navigation (a patient letter was sent at week 2 and a navigator outreach phone call at week 4). Patients, physicians, and practices were unblinded to treatment assignment. Main Outcomes and Measures: The primary outcome was completion of recommended follow-up within 120 days of study enrollment. The secondary outcomes included completion of recommended follow-up within 240 days of enrollment and completion of recommended follow-up within 120 days and 240 days for specific cancer types and levels of risk. Results: Among 11 980 patients (median age, 60 years [IQR, 52-69 years]; 64.8% were women; 83.3% were White; and 15.4% were insured through Medicaid) with an abnormal cancer screening test result for colorectal cancer (8245 patients [69%]), cervical cancer (2596 patients [22%]), breast cancer (1005 patients [8%]), or lung cancer (134 patients [1%]) and abnormal test results categorized as low risk (6082 patients [51%]), medium risk (3712 patients [31%]), or high risk (2186 patients [18%]), the adjusted proportion who completed recommended follow-up within 120 days was 31.4% in the EHR reminders, outreach, and navigation group (n = 3455), 31.0% in the EHR reminders and outreach group (n = 2569), 22.7% in the EHR reminders group (n = 3254), and 22.9% in the usual care group (n = 2702) (adjusted absolute difference for comparison of EHR reminders, outreach, and navigation group vs usual care, 8.5% [95% CI, 4.8%-12.0%], P < .001). The secondary outcomes showed similar results for completion of recommended follow-up within 240 days and by subgroups for cancer type and level of risk for the abnormal screening result. Conclusions and Relevance: A multilevel primary care intervention that included EHR reminders and patient outreach with or without patient navigation improved timely follow-up of overdue abnormal cancer screening test results for breast, cervical, colorectal, and lung cancer. Trial Registration: ClinicalTrials.gov Identifier: NCT03979495.


Assuntos
Diagnóstico Tardio , Detecção Precoce de Câncer , Comunicação em Saúde , Neoplasias , Atenção Primária à Saúde , Sistemas de Alerta , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Neoplasias Pulmonares/diagnóstico , Programas de Rastreamento/métodos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Assistência ao Convalescente , Fatores de Tempo , Diagnóstico Tardio/prevenção & controle , Diagnóstico Tardio/estatística & dados numéricos , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Ensaios Clínicos Pragmáticos como Assunto , Estados Unidos/epidemiologia , Idoso , Sistemas de Alerta/estatística & dados numéricos , Registros Eletrônicos de Saúde , Navegação de Pacientes , Comunicação em Saúde/métodos
10.
JAMA Netw Open ; 6(8): e2328627, 2023 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-37566414

RESUMO

Importance: Medication for opioid use disorder (MOUD) (eg, buprenorphine and naltrexone) can be offered in primary care, but barriers to implementation exist. Objective: To evaluate an implementation intervention over 2 years to explore experiences and perspectives of multidisciplinary primary care (PC) teams initiating or expanding MOUD. Design, Setting, and Participants: This survey-based and ethnographic qualitative study was conducted at 12 geographically and structurally diverse primary care clinics that enrolled in a hybrid effectiveness-implementation study from July 2020 to July 2022 and included PC teams (prescribing clinicians, nonprescribing behavioral health care managers, and consulting psychiatrists). Survey data analysis was conducted from February to April 2022. Exposure: Implementation intervention (external practice facilitation) to integrate OUD treatment alongside existing collaborative care for mental health services. Measures: Data included (1) quantitative surveys of primary care teams that were analyzed descriptively and triangulated with qualitative results and (2) qualitative field notes from ethnographic observation of clinic implementation meetings analyzed using rapid assessment methods. Results: Sixty-two primary care team members completed the survey (41 female individuals [66%]; 1 [2%] American Indian or Alaskan Native, 4 [7%] Asian, 5 [8%] Black or African American, 5 [8%] Hispanic or Latino, 1 [2%] Native Hawaiian or Other Pacific Islander, and 46 [4%] White individuals), of whom 37 (60%) were between age 25 and 44 years. An analysis of implementation meetings (n = 362) and survey data identified 4 themes describing multilevel factors associated with PC team provision of MOUD during implementation, with variation in their experience across clinics. Themes characterized challenges with clinical administrative logistics that limited the capacity to provide rapid access to care and patient engagement as well as clinician confidence to discuss aspects of MOUD care with patients. These challenges were associated with conflicting attitudes among PC teams toward expanding MOUD care. Conclusions and Relevance: The results of this survey and qualitative study of PC team perspectives suggest that PC teams need flexibility in appointment scheduling and the capacity to effectively engage patients with OUD as well as ongoing training to maintain clinician confidence in the face of evolving opioid-related clinical issues. Future work should address structural challenges associated with workload burden and limited schedule flexibility that hinder MOUD expansion in PC settings.


Assuntos
Transtornos Relacionados ao Uso de Opioides , Atenção Primária à Saúde , Adulto , Feminino , Humanos , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Indígena Americano ou Nativo do Alasca/estatística & dados numéricos , Analgésicos Opioides/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/etnologia , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos , Masculino , Equipe de Assistência ao Paciente/estatística & dados numéricos , Asiático/estatística & dados numéricos , Negro ou Afro-Americano/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Brancos/estatística & dados numéricos , Agendamento de Consultas , Carga de Trabalho
11.
Afr J Prim Health Care Fam Med ; 15(1): e1-e7, 2023 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-37403682

RESUMO

BACKGROUND: The use of herbal medicine (HM) as a self-management practice for treating various diseases has gained popularity worldwide. Consumers co-administer herbal products with conventional medicine without the knowledge of possible herb-drug interaction (HDI). AIM: This study aimed to assess patients' perception and use of HM and their knowledge of HDI. SETTING: Participants attending primary health care (PHC) clinics in three provinces (Gauteng, Mpumalanga and Free State), South Africa, were recruited. METHODS: Focus group discussions comprising a total of thirty (N = 30) participants were conducted using a semi-structured interview guide. Discussions were audio-recorded and then transcribed verbatim. Data were analysed using thematic content analysis. RESULTS: Reasons for using HM, sources of information on HM, co-administration of HM and prescribed medicine, disclosure of the use of HM, PHC nurses' attitudes and not having time to engage were frequently discussed. Respondents' lack of knowledge and perceptions about HDI and their dissatisfaction with prescribed medicine because of experienced side effects were also discussed. CONCLUSION: Because of the lack of discussions and non-disclosure about HM in PHC clinics, patients are at risk of experiencing HDIs. Primary health care providers should regularly enquire about HM use on every patient, to identify and prevent HDIs. The lack of knowledge about HDIs by patients further compromises the safety of HM.Contribution: The results highlighted the lack of knowledge of HDI by patients thus assisting the healthcare stakeholders in South Africa to implement measures to educate patients attending PHC clinics.


Assuntos
Atenção à Saúde , Interações Ervas-Drogas , Medicina Herbária , Medicamentos sob Prescrição , Atenção Primária à Saúde , Humanos , Atenção à Saúde/métodos , Atenção à Saúde/estatística & dados numéricos , Grupos Focais , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , África do Sul/epidemiologia , Medicina Herbária/métodos , Fitoterapia/métodos , Medicamentos sob Prescrição/farmacologia , Medicamentos sob Prescrição/uso terapêutico , Quimioterapia Combinada
12.
J Adolesc Health ; 73(4): 790-794, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37367704

RESUMO

PURPOSE: Despite long-term emphasis on the medical home for children, little research focuses on adolescents. This study examines adolescent past-year attainment of medical home, its components, and subgroup differences among demographic and mental/physical health condition categories. METHODS: Utilizing the 2020-21 National Survey of Children's Health (NSCH), ages 10-17 (N = 42,930), we determined medical home attainment and its 5 components and subgroup differences utilizing multivariable logistic regression: sex; race/ethnicity; income; caregiver education; insurance; language spoken at home; region; and health conditions: physical, mental, both, or none. RESULTS: Forty-five percent had a medical home with lower rates among those who were as follows: not White non-Hispanic; lower income; uninsured; in non-English-speaking households; adolescents whose caregivers lacked a college degree; and adolescents with mental health conditions (p range = .01-<.0001). Differences for medical home components were similar. DISCUSSION: Given low medical home rates, ongoing differences and high mental illness rates, efforts are needed to improve adolescent medical home access.


Assuntos
Medicina do Adolescente , Serviços de Saúde da Criança , Acesso aos Serviços de Saúde , Assistência Centrada no Paciente , Atenção Primária à Saúde , Adolescente , Criança , Humanos , Serviços de Saúde da Criança/estatística & dados numéricos , Etnicidade , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hispânico ou Latino , Renda , Assistência Centrada no Paciente/estatística & dados numéricos , Estados Unidos/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Medicina do Adolescente/normas , Medicina do Adolescente/estatística & dados numéricos
13.
BMC Psychiatry ; 23(1): 280, 2023 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-37081409

RESUMO

BACKGROUND: Few studies have examined the prevalence of mental, neurological and substance use (MNS) conditions, case detection and treatment in primary healthcare in rural settings in Africa. We assessed prevalence and case detection at primary healthcare facilities in low-resource rural settings in Ghana. METHODS: A cross-sectional survey was conducted at the health facility level in three demonstration districts situated in Bongo (Upper East Region), Asunafo North (Ahafo Region) and Anloga (Volta Region) in Ghana. The study participants were resident adult (> 17 years) out-patients seeking healthcare at primary care facilities in each of the three demonstration districts. Data were collected on five priority MNS conditions: depression, psychosis, suicidal behaviour, epilepsy and alcohol use disorders. RESULTS: Nine hundred and nine (909) people participated in the survey. The prevalence of probable depression was 15.6% (142/909), probable psychotic symptoms was 12% (109/909), probable suicidal behaviour was 11.8% (107/909), probable epilepsy was 13.1% (119/909) and probable alcohol use disorders was 7.8% (71/909). The proportion of missed detection for cases of depression, self-reported psychotic symptoms, epilepsy and alcohol use disorders (AUD) ranged from 94.4 to 99.2%, and was similar across study districts. Depression was associated with self-reported psychotic symptoms (RR: 1.68; 95% CI: 1.12-1.54). For self-reported psychotic symptoms, a reduced risk was noted for being married (RR: 0.62; 95% CI: 0.39-0.98) and having a tertiary level education (RR: 0.12; 95% CI: 0.02-0.84). Increased risk of suicidal behaviour was observed for those attending a health facility in Asunafo (RR: 2.31; 95% CI: 1.27-4.19) and Anloga districts (RR: 3.32; 95% CI: 1.93-5.71). Age group of 35 to 44 years (RR: 0.43; 95% CI: 0.20-0.90) was associated with reduced risk of epilepsy. Being female (RR: 0.19; 95% CI: 0.12-0.31) and having a tertiary education (RR: 0.27; 95% CI: 0.08-0.92) were associated with reduced risk of AUD. CONCLUSIONS: Our study found a relatively high prevalence of probable MNS conditions, and very low detection and treatment rates in rural primary care settings in Ghana. There is a need to improve the capacity of primary care health workers to detect and manage MNS conditions.


Assuntos
Alcoolismo , Depressão , Epilepsia , Transtornos Psicóticos , Ideação Suicida , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Alcoolismo/terapia , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/terapia , Epilepsia/diagnóstico , Epilepsia/epidemiologia , Epilepsia/terapia , Gana/epidemiologia , Pesquisas sobre Atenção à Saúde , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/terapia , Serviços de Saúde Rural/estatística & dados numéricos
14.
AIDS Care ; 35(4): 466-473, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-35109735

RESUMO

HIV incidence remains high among South Africans, with low uptake of preventative measures such as condom use. Pre-exposure prophylaxis (PrEP), which protects HIV-negative individuals from infection, was first introduced in SA in 2016. This study determined the knowledge of PrEP among university students (n = 282) and primary health care clinic users (n = 358) in KwaZulu-Natal, South Africa. Data were collected using a cross-sectional survey. The study population was at high-risk of HIV infection, with early age of sexual debut, multiple concurrent sexual partners and inconsistent condom usage. Only 12.3% (n = 79) stated that they had a full understanding of PrEP, which was higher among university students (9.8%; n = 63) than clinic users (2.5%; n = 16; p < 0.001). Specific PrEP knowledge was, however, low. Health Science students did not have a better knowledge than students from other faculties. Neither did users of clinics offering PrEP have a better knowledge than users of clinics not offering PrEP. Moreover, few participants (15%; n = 96) were aware of the availability of PrEP at their local clinic. Interventions to address the low level of PrEP knowledge within the population are required, to reduce the high HIV incidence.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Conhecimentos, Atitudes e Prática em Saúde , Profilaxia Pré-Exposição , População da África Austral , Humanos , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Estudos Transversais , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Profilaxia Pré-Exposição/métodos , Profilaxia Pré-Exposição/estatística & dados numéricos , África do Sul/epidemiologia , Conhecimento do Paciente sobre a Medicação/estatística & dados numéricos , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Instituições de Assistência Ambulatorial , Universidades , População da África Austral/psicologia , População da África Austral/estatística & dados numéricos
15.
Intern Med J ; 53(7): 1188-1195, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-34779559

RESUMO

BACKGROUND: Nationally, Indigenous Australians are more likely to have diabetes and diabetic retinopathy (DR) than non-Indigenous Australians. However, the prevalence of DR and impaired vision in regional primary care settings is unclear. AIM: To describe the prevalence and severity of DR and presenting vision level among Indigenous Australian adults with diabetes attending an indigenous primary care clinic in regional Australia. METHODS: Participants underwent nurse-led retinal imaging and DR screening with offsite retinal grading in the integrated Diabetes Education and Eye Screening (iDEES) project implemented at a regional indigenous primary healthcare setting between January 2018 and March 2020. RESULTS: Of 172 eligible adults, 135 (79%) were recruited and screened for DR and vision level. The median age was 56 (46-67) years, 130 (96%) had type 2 diabetes of median (interquartile range) duration 6 (2-12) years and 48 (36%) were male. Images from 132 (97.8%) participants were gradable. DR was present in 38 (29%) participants: mild non-proliferative in 33 (25%); moderate-severe in three (2.5%); and sight-threatening two (1.5%). Subnormal presenting vision was present in 33%. CONCLUSIONS: A nurse-led model of care integrating diabetes eye screening and education at a single visit was successful at recruiting Indigenous Australian adults with diabetes, screening their vision and acquiring a high rate of gradable images. Even for a short duration of known diabetes, DR was present in three out of 10 patients screened.


Assuntos
Povos Aborígenes Australianos e Ilhéus do Estreito de Torres , Retinopatia Diabética , Serviços de Saúde do Indígena , Programas de Rastreamento , Papel do Profissional de Enfermagem , Baixa Visão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Austrália/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/etiologia , Programas de Rastreamento/métodos , Programas de Rastreamento/enfermagem , Programas de Rastreamento/estatística & dados numéricos , Prevalência , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Transtornos da Visão/diagnóstico , Transtornos da Visão/epidemiologia , Transtornos da Visão/etiologia , Baixa Visão/diagnóstico , Baixa Visão/epidemiologia , Baixa Visão/etiologia , Idoso , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/estatística & dados numéricos , Serviços de Saúde do Indígena/provisão & distribuição , Povos Aborígenes Australianos e Ilhéus do Estreito de Torres/estatística & dados numéricos
16.
J Am Geriatr Soc ; 71(4): 1259-1266, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36585893

RESUMO

BACKGROUND: Primary care is essential for persons with Alzheimer's disease and related dementias (ADRD). Prior research suggests that the propensity to provide high-quality, continuous primary care varies by provider setting, but the settings used by Medicare-Medicaid dual-eligibles with ADRD have not been described at the population level. METHODS: Using 2012-2018 Medicare data, we identified dual-eligibles with ADRD. For each person-year, we identified primary care visits occurring in six settings. We calculated descriptive statistics for beneficiaries with a majority of visits in each setting, and conducted a k-means cluster analysis to determine utilization patterns, using the standardized count of primary care visits in each setting. RESULTS: Each year from 2012 to 2018, at least 45.6% of dual-eligibles with ADRD received a majority of their primary care in nursing facilities, while at least 25.2% did so in physician offices. Over time, the share relying on nursing facilities for primary care decreased by 5.2 percentage points, offset by growth in Federally Qualified Health Centers (FQHCs) and miscellaneous settings (2.3 percentage points each). Dual-eligibles relying on nursing facilities had more annual primary care visits (16.1) than those relying on other settings (range: 6.8-10.7 visits). Interpersonal care continuity was also higher in nursing facilities (97.0%) and physician offices (87.9%) than in FQHCs (54.2%), rural health clinics (RHCs, 46.6%), or hospital-based clinics (56.8%). Among dual-eligibles without care continuity, 82.7% were assigned to a cluster with few primary care visits. CONCLUSIONS: A trend toward care in different settings likely reflects improved access to patient-centered primary care. Low rates of interpersonal care continuity in FQHCs, RHCs, and physician offices may warrant concern, unless providers in these settings function as a care team. Nonetheless, every healthcare system encounter presents an opportunity to designate a primary care provider for dual-eligibles with ADRD who use little or no primary care.


Assuntos
Doença de Alzheimer , Medicaid , Medicare , Enfermagem de Atenção Primária , Atenção Primária à Saúde , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/enfermagem , Doença de Alzheimer/terapia , Medicaid/estatística & dados numéricos , Medicare/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Visita a Consultório Médico/tendências , Assistência Centrada no Paciente , Enfermagem de Atenção Primária/métodos , Enfermagem de Atenção Primária/estatística & dados numéricos , Enfermagem de Atenção Primária/tendências , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/tendências , Qualidade da Assistência à Saúde , Instalações de Saúde
17.
Aust J Prim Health ; 29(2): 137-141, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36403292

RESUMO

This paper examines the implications of the second sentence in Tudor Harts statement about inverse care - that its operation was strongest when exposed to market forces. In the Australian context, we briefly review some available evidence for inverse care in three groups - Aboriginal and Torres Strait Islander people and those living in remote and socioeconomically disadvantaged areas. We then discuss the extent to which these examples can be attributed to the operation of supply-and-demand within Australia's hybrid fee-for-service system in general practice. Our analysis suggests disparities in workforce supply and the ability of disadvantaged groups to seek preventive and proactive care are critical factors. These, in turn, suggest the need to fund general practice to be responsible for proactive and preventive care of disadvantaged population groups alongside broader structural reforms in workforce, education and taxation.


Assuntos
Povos Aborígenes Australianos e Ilhéus do Estreito de Torres , Serviços de Saúde do Indígena , Atenção Primária à Saúde , Populações Vulneráveis , Humanos , Austrália/epidemiologia , Povos Aborígenes Australianos e Ilhéus do Estreito de Torres/estatística & dados numéricos , Serviços de Saúde do Indígena/economia , Serviços de Saúde do Indígena/provisão & distribuição , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/estatística & dados numéricos , Recursos Humanos , Populações Vulneráveis/estatística & dados numéricos
18.
Health Serv Res ; 58(2): 264-270, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36527443

RESUMO

OBJECTIVE: To examine whether primary care physician (PCP) comprehensiveness is associated with Medicare beneficiaries' overall rating of care from their PCP and staff. DATA SOURCES: We linked Medicare claims with survey data from Medicare beneficiaries attributed to Comprehensive Primary Care Plus (CPC+) physicians and practices. STUDY DESIGN: We performed regression analyses of the associations between two claims-based measures of PCP comprehensiveness in 2017 and beneficiaries' rating of care from their PCP and practice staff in 2018. DATA COLLECTION/EXTRACTION METHODS: The analytic sample included 6228 beneficiaries cared for by 3898 PCPs. Regressions controlled for beneficiary, physician, practice, and market characteristics. PRINCIPAL FINDINGS: Beneficiaries with more comprehensive PCPs rated care from their PCP and practice staff higher than did those with less comprehensive PCPs. For each comprehensiveness measure, beneficiaries whose PCP was in the 75th percentile were more likely than beneficiaries whose PCP was in the 25th percentile to rate their care highly (2 percentage point difference, p = 0.02). CONCLUSIONS: Medicare beneficiaries with more comprehensive PCPs rate overall care from their PCPs and staff higher than those with less comprehensive PCPs.


Assuntos
Medicare , Médicos de Atenção Primária , Qualidade da Assistência à Saúde , Assistência Integral à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Medicare/estatística & dados numéricos , Médicos de Atenção Primária/normas , Médicos de Atenção Primária/estatística & dados numéricos , Humanos , Idoso , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos
19.
Trab. Educ. Saúde (Online) ; 21: e02311227, 2023. tab, graf
Artigo em Português | LILACS | ID: biblio-1509224

RESUMO

Resumo Este artigo teve como objetivo analisar os tipos de vínculos de trabalho das enfermeiras da Atenção Primária à Saúde no Brasil. Tratou-se de um estudo transversal de abordagem quantitativa e descritiva. Utilizaram-se os microdados secundários referentes ao desdobramento da pesquisa de avaliação externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica. Quanto ao tipo de vínculo, com exceção da Região Norte (33,70%), todas as outras regiões apresentaram como principal respondente servidoras públicas estatutárias: Sul (66,20%), Centro-Oeste (56,50%), Nordeste (40,33%), Sudeste (36,69%). Enfermeiras com contrato temporário pela administração pública e contrato temporário por prestação de serviço tiveram participação importante no Nordeste (29,51% e 19,33%) e Centro-Oeste (16,03% e 17,86%). Contrato e empregado via Consolidação das Leis do Trabalho tiveram mais expressão no Sudeste (23,54% e 8,27%) e no Sul (5,93% e 19,31%). No Sudeste, foi expressiva a participação de trabalhadoras contratadas por organizações sociais de saúde. Notou-se a presença crescente de vínculos precários de trabalho em detrimento dos vínculos estáveis. As novas formas de organização flexível das relações de trabalho trazem impacto significativo ao processo de trabalho, sobrecarregam as enfermeiras, em condições de trabalho inadequadas, e comprometem a qualidade da assistência, reduzindo a resolutividade da Atenção Primária.


Abstract This article aimed to analyze the types of work bond of nurses from Primary Health Care in Brazil. This was a cross-sectional study of a quantitative and descriptive approach. Secondary microdata related to the breakdown of the external evaluation research of the Access Improvement Program and the Quality of Basic Care were used. As for the type of bond, except for the Northern Region (33.70%), all other regions presented as the main respondent for statutory public servants: South (66.20%), Central-West (56.50%), Northeast (40.33%), Southeast (36.69%). Nurses with temporary contracts for public administration and temporary service contracts had important participation in the Northeast (29.51% and 19.33%) and Central-West (16.03% and 17.86%). Contract and employee through Consolidation of Labor Laws had more expression in the Southeast (23.54% and 8.27%) and in the South (5.93% and 19.31%). In the Southeast, the participation of workers employed by social health organizations was expressive. The growing presence of precarious labor links was noted, to the detriment of stable bonds. The new forms of flexible organization of work relationships bring significant impact to the work process, overload nurses in inadequate working conditions, and compromise the quality of care, reducing the resolubility of Primary Care.


Resumen El presente artículo tuvo como objetivo analizar los tipos de vínculos laborales de las enfermeras de Atención Primaria de Salud en Brasil. Se trata de un estudio transversal de enfoque cuantitativo y descriptivo. Se utilizaron microdatos secundarios relacionados con la división de la investigación de evaluación externa del Programa de Mejora del Acceso y la Calidad de la Atención Básica. En cuanto al tipo de vínculo, a excepción de la Región Norte (33,70%), todas las demás regiones se presentaron como principal demandado para los funcionarios públicos estatutarios: Sur (66,20%), Centro Oeste (56,50%), Noreste (40,33%), Sureste (36,69%). Las enfermeras con contratos temporales de administración pública y contratos temporales de servicios tuvieron una participación importante en el Nordeste (29,51% y 19,33%) y Centro Oeste (16,03% y 17,86%). Contrato y empleado a través de la Consolidación de Las Leyes Laborales tuvieron más expresión en el Sudeste (23,54% y 8,27%) y en el Sur (5,93% y 19,31%). En el Sudeste, la participación de los trabajadores empleados por las organizaciones de salud social fue expresiva. Se observó la creciente presencia de vínculos laborales precarios, en detrimento de vínculos estables. Las nuevas formas de organización flexible de las relaciones laborales tienen un impacto significativo en el proceso de trabajo, sobrecargan a las enfermeras en condiciones laborales inadecuadas y comprometen la calidad de la asistencia, reduciendo la solubilidad de la Atención Primaria.


Assuntos
Humanos , Masculino , Feminino , Atenção Primária à Saúde/estatística & dados numéricos , Emprego/estatística & dados numéricos , Enfermeiras e Enfermeiros/estatística & dados numéricos , Brasil , Mobilidade Ocupacional , Estudos Transversais , Entrevistas como Assunto/estatística & dados numéricos , Pesquisa Qualitativa , Análise de Dados , Publicações Governamentais como Assunto
20.
Geriatr., Gerontol. Aging (Online) ; 17: 0230033, 2023. tab
Artigo em Inglês | LILACS | ID: biblio-1510613

RESUMO

OBJECTIVES: To assess functional disability and associated factors in older patients cared for at a large Brazilian urban area. METHODS: This is a cross-sectional study performed at a primary health care unit in the city of São Paulo, Brazil. Participants were selected via probabilistic sampling of 400 older individuals. We used a sociodemographic and health questionnaire along with instruments for assessing fear of falling (FES-I), cognitive function (MMSE), and depression symptoms (GDS-15). For dependent variables, we used instruments for assessing basic activities (BADL; Katz) and instrumental activities of daily living (IADL; Lawton). Factors associated with functional disability were analyzed via logistic regression models. RESULTS: The mean age of participants was 75.23 (SD = 8.53); 63.20% were female, 27.00% were dependent in BADL and 39.25%, in IADL. Older individuals with better cognitive function and who had not been hospitalized in the previous year were less prone to functional disabilities. Factors such as older age, more depression symptoms, and greater fear of falling were more linked to disabilities in BADL. Factors such as older age, female sex, and greater fear of falling were more linked to disabilities in IADL. CONCLUSIONS: The prevalence of disability in BADL and IADL in the studied sample was high. Modifiable and non-modifiable factors were associated with functional disability. These results may help primary health care professionals understand the risk factors for functional disability in the older population


OBJETIVOS: Avaliar a incapacidade funcional e fatores associados em pacientes idosos atendidos em um grande centro urbano brasileiro. METODOLOGIA: Estudo transversal realizado em uma Unidade Básica de Saúde na cidade de São Paulo, Brasil. A seleção dos participantes foi por meio de amostragem probabilística de 400 indivíduos idosos. Foi utilizado um questionário sociodemográfico, de saúde e instrumentos para avaliar medo de queda (FES-I), status cognitivo (MEEM) e sintomas depressivos (GDS-15). Para as variáveis dependentes, utilizou-se os instrumentos para avaliar as atividades básicas (ABVD; Katz) e atividades instrumentais de vida diária (Lawton; AIVD). Os fatores associados à incapacidade funcional foram analisados por meio de modelos de regressão logística. RESULTADOS: A média de idade dos participantes foi de 75,23 (DP = 8,53), 63,20% eram do sexo feminino, 27,00% eram dependentes para ABVD e 39,25% para as AIVD. Indivíduos idosos com melhor status cognitivo e que não estiveram internados no último ano eram menos propensos às incapacidades funcionais. Fatores como ter mais idade, mais sintomas depressivos e mais medo de queda eram mais propensos às incapacidades das ABVD. Fatores como ter mais idade, ser do sexo feminino e mais medo de queda foram mais propensos às incapacidades das AIVD. CONCLUSÕES: A prevalência de incapacidade para ABVD e AIVD na amostra estudada foi alta. Fatores modificáveis e não modificáveis foram associados à incapacidade funcional. Esses resultados podem ajudar os profissionais da atenção primária à saúde a entenderem os fatores de risco de incapacidade funcional na população mais velha


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Atenção Primária à Saúde/estatística & dados numéricos , Avaliação Geriátrica , Idoso Fragilizado/estatística & dados numéricos , Estado Funcional , Prevalência , Estudos Transversais , Fatores Sociodemográficos
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