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Hacia promoc. salud ; 26(2): 235-251, jul.-dic. 2021. tab, graf
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1339958


Resumo Objetivo: analisar as situações de vulnerabilidade vivenciadas por adolescentes que praticam atos infracionais. Materiais e Métodos: trata-se de uma revisão integrativa de literatura, realizada nas bases de dados Scientific Eletronic Library Online (Scielo), Biblioteca Virtual em Saúde (BVS) e Medical Literature Analysis and Retrieval System Online (Medline), que resultou em 33 estudos incluídos, publicados entre os anos de 2009 a 2019, e, que após análise de conteúdo semântica, originou quatro categorias. Resultados: os resultados foram apresentados nas categorias: relações familiares conflituosas; envolvimento com álcool e drogas; situações sociodemográficas desfavoráveis; vulnerabilidade programática e a ausência do Estado. Conclusão: este estudo aponta como contribuição para a prática dos profissionais, sobretudo da atenção primária, estratégias para analisar as situações de vulnerabilidades que adolescentes infratores vivenciam, e assim, atuar na promoção da saúde, minimização dos agravos e auxílio para a reinserção social.

Resumen Objetivo: analizar las situaciones de vulnerabilidad que viven los adolescentes infractores. Materiales y métodos: se trata de una revisión integradora de la literatura, realizada en las bases de datos Scientific Electronic Electronic Library Online (Scielo), Virtual Health Library (BVS) y Medical Literature Analysis and Retrieval System Online (Medline), que resultó en 33 estudios incluidos, publicado entre los años 2009 a 2019, y que luego del análisis de contenido semántico, se originaron cuatro categorías. Resultados: los resultados se presentaron en las categorías: relaciones familiares conflictivas; implicación con alcohol y drogas; situaciones sociodemográficas desfavorables; vulnerabilidad programática y ausencia del Estado. Conclusión: este estudio señala, como aporte a la práctica de los profesionales, especialmente en atención primaria, estrategias para analizar las situaciones de vulnerabilidad que viven los adolescentes infractores, y así, actuar en la promoción de la salud, minimización de lesiones y asistencia para la reinserción en comunidad.

Abstract Objective: To analyze the situations of vulnerability experienced by adolescent offenders. Method: This is an integrative literature review carried out in the Scientific Electronic Library Online (Scielo), Virtual Health Library (VHL) and Medical Literature Analysis and Retrieval System Online (Medline) databases which resulted in 33 included studies, published between the years 2009 and 2019 and that, after analysis of semantic content, originated four categories. Results: The results were presented in the categories: conflicting family relationships; involvement with alcohol and drugs; unfavorable sociodemographic situations; programmatic vulnerability and the absence of the State. Conclusion: As a contribution to the practice of professionals, especially in primary care, this study points out strategies to analyze the situations of vulnerability that adolescent offenders experience, and thus, act in the promotion of health, minimization of injuries and assistance for social reintegration.

Cochrane Database Syst Rev ; 10: CD011589, 2021 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-34637526


BACKGROUND: Patient-reported outcomes measures (PROMs) assess a patient's subjective appraisal of health outcomes from their own perspective. Despite hypothesised benefits that feedback  on PROMs can support decision-making in clinical practice and improve outcomes, there is uncertainty surrounding the effectiveness of PROMs feedback. OBJECTIVES: To assess the effects of PROMs feedback to patients, or healthcare workers, or both on patient-reported health outcomes and processes of care. SEARCH METHODS: We searched MEDLINE, Embase, CENTRAL, two other databases and two clinical trial registries on 5 October 2020. We searched grey literature and consulted experts in the field. SELECTION CRITERIA: Two review authors independently screened and selected studies for inclusion. We included randomised trials directly comparing the effects on outcomes and processes of care of PROMs feedback to healthcare professionals and patients, or both with the impact of not providing such information. DATA COLLECTION AND ANALYSIS: Two groups of two authors independently extracted data from the included studies and evaluated study quality. We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. We conducted meta-analyses of the results where possible. MAIN RESULTS: We identified 116 randomised trials which assessed the effectiveness of PROMs feedback in improving processes or outcomes of care, or both in a broad range of disciplines including psychiatry, primary care, and oncology. Studies were conducted across diverse ambulatory primary and secondary care settings in North America, Europe and Australasia. A total of 49,785 patients were included across all the studies. The certainty of the evidence varied between very low and moderate. Many of the studies included in the review were at risk of performance and detection bias. The evidence suggests moderate certainty that PROMs feedback probably improves quality of life (standardised mean difference (SMD) 0.15, 95% confidence interval (CI) 0.05 to 0.26; 11 studies; 2687 participants), and leads to an increase in patient-physician communication (SMD 0.36, 95% CI 0.21 to 0.52; 5 studies; 658 participants), diagnosis and notation (risk ratio (RR) 1.73, 95% CI 1.44 to 2.08; 21 studies; 7223 participants), and disease control (RR 1.25, 95% CI 1.10 to 1.41; 14 studies; 2806 participants). The intervention probably makes little or no difference for general health perceptions (SMD 0.04, 95% CI -0.17 to 0.24; 2 studies, 552 participants; low-certainty evidence), social functioning (SMD 0.02, 95% CI -0.06 to 0.09; 15 studies; 2632 participants; moderate-certainty evidence), and pain (SMD 0.00, 95% CI -0.09 to 0.08; 9 studies; 2386 participants; moderate-certainty evidence). We are uncertain about the effect of PROMs feedback on physical functioning (14 studies; 2788 participants) and mental functioning (34 studies; 7782 participants), as well as fatigue (4 studies; 741 participants), as the certainty of the evidence was very low. We did not find studies reporting on adverse effects defined as distress following or related to PROM completion. AUTHORS' CONCLUSIONS: PROM feedback probably produces moderate improvements in communication between healthcare professionals and patients as well as in diagnosis and notation, and disease control, and small improvements to quality of life. Our confidence in the effects is limited by the risk of bias, heterogeneity and small number of trials conducted to assess outcomes of interest. It is unclear whether   many of these improvements are clinically meaningful or sustainable in the long term. There is a need for more high-quality studies in this area, particularly studies which employ cluster designs and utilise techniques to maintain allocation concealment.

Pessoal de Saúde , Qualidade de Vida , Retroalimentação , Humanos , Medidas de Resultados Relatados pelo Paciente , Atenção Primária à Saúde
BMJ ; 375: n2183, 2021 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-34610915


OBJECTIVE: To update a previous individual participant data meta-analysis and determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9), the most commonly used depression screening tool in general practice, for detecting major depression overall and by study or participant subgroups. DESIGN: Systematic review and individual participant data meta-analysis. DATA SOURCES: Medline, Medline In-Process, and Other Non-Indexed Citations via Ovid, PsycINFO, Web of Science searched through 9 May 2018. REVIEW METHODS: Eligible studies administered the PHQ-9 and classified current major depression status using a validated semistructured diagnostic interview (designed for clinician administration), fully structured interview (designed for lay administration), or the Mini International Neuropsychiatric Interview (MINI; a brief interview designed for lay administration). A bivariate random effects meta-analytic model was used to obtain point and interval estimates of pooled PHQ-9 sensitivity and specificity at cut-off values 5-15, separately, among studies that used semistructured diagnostic interviews (eg, Structured Clinical Interview for Diagnostic and Statistical Manual), fully structured interviews (eg, Composite International Diagnostic Interview), and the MINI. Meta-regression was used to investigate whether PHQ-9 accuracy correlated with reference standard categories and participant characteristics. RESULTS: Data from 44 503 total participants (27 146 additional from the update) were obtained from 100 of 127 eligible studies (42 additional studies; 79% eligible studies; 86% eligible participants). Among studies with a semistructured interview reference standard, pooled PHQ-9 sensitivity and specificity (95% confidence interval) at the standard cut-off value of ≥10, which maximised combined sensitivity and specificity, were 0.85 (0.79 to 0.89) and 0.85 (0.82 to 0.87), respectively. Specificity was similar across reference standards, but sensitivity in studies with semistructured interviews was 7-24% (median 21%) higher than with fully structured reference standards and 2-14% (median 11%) higher than with the MINI across cut-off values. Across reference standards and cut-off values, specificity was 0-10% (median 3%) higher for men and 0-12 (median 5%) higher for people aged 60 or older. CONCLUSIONS: Researchers and clinicians could use results to determine outcomes, such as total number of positive screens and false positive screens, at different PHQ-9 cut-off values for different clinical settings using the knowledge translation tool at STUDY REGISTRATION: PROSPERO CRD42014010673.

Transtorno Depressivo Maior/diagnóstico , Questionário de Saúde do Paciente/normas , Adulto , Fatores Etários , Transtorno Depressivo Maior/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente/estatística & dados numéricos , Escalas de Graduação Psiquiátrica/normas , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Curva ROC , Padrões de Referência , Fatores Sexuais
Syst Rev ; 10(1): 271, 2021 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-34666828


BACKGROUND: Multimorbidity, defined as the co-existence of two or more chronic conditions, presents significant challenges to patients, healthcare providers and health systems. Despite this, there is ongoing uncertainty about the most effective ways to manage patients with multimorbidity. This review updated and narrowed the focus of a previous Cochrane review and aimed to determine the effectiveness of interventions designed to improve outcomes in people with multimorbidity in primary care and community settings, compared to usual care. METHODS: We searched eight databases and two trials registers up to 9 September 2019. Two review authors independently screened potentially eligible titles and selected studies, extracted data, evaluated study quality and judged the certainty of the evidence (GRADE). Interventions were grouped by their predominant focus into care-coordination/self-management support, self-management support and medicines management. Main outcomes were health-related quality of life (HRQoL) and mental health. Meta-analyses were conducted, where possible, but the synthesis was predominantly narrative. RESULTS: We included 16 RCTs with 4753 participants, the majority being older adults with at least three conditions. There were eight care-coordination/self-management support studies, four self-management support studies and four medicines management studies. There was little or no evidence of an effect on primary outcomes of HRQoL (MD 0.03, 95% CI -0.01 to 0.07, I2 = 39%) and mental health or on secondary outcomes with a small number of studies reporting that care coordination may improve patient experience of care and self-management support may improve patient health behaviours. Overall, the certainty of the evidence was graded as low due to significant variation in study participants and interventions. CONCLUSIONS: There are remaining uncertainties about the effectiveness of interventions for people with multimorbidity, despite the growing number of RCTs conducted in this area. Our findings suggest that future research should consider patient experience of care, optimising medicines management and targeted patient health behaviours such as exercise.

Multimorbidade , Autogestão , Idoso , Doença Crônica , Humanos , Atenção Primária à Saúde , Qualidade de Vida
BMJ Open ; 11(10): e051409, 2021 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-34663662


OBJECTIVE: To summarise the literature on frequent attendances to hospital emergency departments (EDs) and describe sociodemographic and clinical characteristics of children who attend EDs frequently. SETTING: Hospital EDs. PARTICIPANTS: Children <21 years, attending hospital EDs frequently. PRIMARY OUTCOME MEASURES: Outcomes measures were defined separately in each study, and were predominantly the number of ED attendances per year. RESULTS: We included 21 studies representing 6 513 627 children. Between 0.3% and 75% of all paediatric ED users were frequent users. Most studies defined four or more visits per year as a 'frequent ED' usage. Children who were frequent ED users were more likely to be less than 5 years old. In the USA, patients with public insurance were more likely to be frequent attenders. Frequent ED users more likely to be frequent users of primary care and have long-term conditions; the most common diagnoses were infections and gastroenteritis. CONCLUSIONS: The review included a wide range of information across various health systems, however, children who were frequent ED users have some universal characteristics in common. Policies to reduce frequent attendance might usefully focus on preschool children and supporting primary care in responding to primary care oriented conditions.

Serviço Hospitalar de Emergência , Atenção Primária à Saúde , Criança , Pré-Escolar , Hospitais , Humanos , Assistência Médica , Periodicidade
Enferm. foco (Brasília) ; 12(7, supl 1): 42-48, out. 2021. ilus, tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1293341


Objetivo: Analisar modelos de formação de enfermeiros na Atenção Primária à Saúde na literatura, considerando publicações de 2009 a 2019. Método: Scoping Review nas bases PubMed; BVS; ProQuest; EMBASE e Scielo. Os critérios de inclusão integram artigos em português, inglês, francês e espanhol. E como exclusão, ausência de resumos, artigos duplicados e não relacionados à formação de enfermagem na Atenção Primária. Resultados: Dos 369 artigos, 28 discutiam a formação de saúde para a atenção primária, em diferentes profissões. Dentre estes, 07 estavam relacionados à formação em enfermagem para a APS. Predominou o nível de evidências VII, classificando-os como estudos oriundos de relatório de comitês de especialistas. Conclusões: As evidências reafirmam o fortalecimento e a implementação da Educação Interprofissional, como uma abordagem de ensino que qualifica o processo de formação em enfermagem, valorizando as competências colaborativas. Conclui-se que há preocupação dos pesquisadores, de que o ensino de Enfermagem se desenvolva na perspectiva da formação, onde os estudantes possam desenvolver consciência profissional crítico-política para atuação na APS, com capacidade resolutiva na saúde pública, a partir das competências adquiridas. (AU)

Objective: To analyze nursing education models in Primary Health Care in the literature, considering publications from 2009 to 2019. Methods: Scoping Review in PubMed databases; VHL; ProQuest; EMBASE and Scielo. Inclusion criteria include articles in Portuguese, English, French and Spanish. And as exclusion, absence of abstracts, duplicate articles and not related to nursing education in Primary Care. Results: Of the 369 articles, 28 discussed health training for primary care, in different professions. Among these, 07 were related to nursing training for PHC. Level of evidence VII prevailed, classifying them as studies originating from expert committee reports. Conclusion: Evidence reaffirms the strengthening and implementation of Interprofessional Education, as a teaching approach that qualifies the nursing education process, valuing collaborative skills. It is concluded that there is concern among researchers that nursing education should be developed from the perspective of training, where students can develop critical-political professional awareness to work in PHC, with resolving capacity in public health, based on acquired skills. (AU)

Objetivo: Analizar modelos de educación en enfermería en Atención Primaria de Salud en la literatura, considerando publicaciones de 2009 a 2019. Métodos: Scoping Review en bases de datos PubMed; VHL; ProQuest; EMBASE y Scielo. Los criterios de inclusión incluyen artículos en portugués, inglés, francés y español. Y como exclusión, ausencia de resúmenes, artículos duplicados y no relacionados con la formación en enfermería en Atención Primaria. Resultados: De los 369 artículos, 28 abordaron la educación en salud para la atención primaria, en diferentes profesiones. Entre estos, 07 estaban relacionados con la formación de enfermería para la APS. Prevaleció el nivel de evidencia VII, clasificándolos como estudios provenientes de informes de comités de expertos. Conclusion: La evidencia reafirma el fortalecimiento e implementación de la Educación Interprofesional, como un enfoque de enseñanza que califica el proceso de formación en enfermería, valorando las habilidades colaborativas. Se concluye que existe preocupación de los investigadores de que la educación en enfermería se desarrolle desde la perspectiva de la formación, donde los estudiantes puedan desarrollar una conciencia profesional crítico-política para trabajar en la APS, con capacidad resolutiva en salud pública, a partir de las competencias adquiridas. (AU)

Atenção Primária à Saúde , Enfermagem , Educação em Enfermagem , Capacitação de Recursos Humanos em Saúde
Enferm. foco (Brasília) ; 12(7, supl 1): 49-54, out. 2021. ilus, tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1337549


Objetivo: Caracterizar, com base na literatura, sistemas e serviços de saúde em âmbito mundial. Método: Trata-se de uma Scoping Review, das bases de dados: Biblioteca Virtual de Saúde, Embase, ProQuest, National Library of Medicine National Institutes of Health e Scientific Electronic Library Online. Utilizou-se os descritores e suas combinações: Health Systems, Health Services, Structure of Services e Primary Health Care, entre 2009 e 2019, disponíveis em espanhol, francês, inglês, português. Foram analisados considerando objetivos dos estudos, tipo de proteção social, prestação de serviços, estrutura e organização da Atenção Primária à Saúde e financiamento. Resultados: Foram incluídos 12 estudos que se aquedaram à proposta da pesquisa. Os sistemas evidenciados estão relacionados aos países Iraque, Equador, Dinamarca, Argentina, Holanda, Canadá, Irlanda, Bélgica, França, Suécia, Reino Unido e Itália. Conclusões: Dentre os sistemas e serviços de saúde dos países analisados, alguns estão orientados pelo modelo de mercado, outros pela oferta pública da atenção à saúde e há aqueles que integram os dois modelos. Os sistemas de saúde devem ofertar serviços que alcancem toda a população, organizados a partir da Atenção Primária à Saúde. Os que adotam o modelo seguridade social são os que mais se aproximam deste cenário. (AU)

Objective: To map, from the literature, health systems and services worldwide, characterizing them as to the type of social protection, service provision, organizational structure of the PHC and origin of financing. Methods: This is a Scoping Review of databases: Virtual Health Library, Embase, ProQuest, National Library of Medicine, National Institutes of Health and Scientific Electronic Library Online. The descriptors and their combinations were used: Health Systems, Health Services, Structure of Services and Primary Health Care, between 2009 and 2019, available in Spanish, French, English, Portuguese. They were analyzed considering study objectives, type of social protection, service provision, structure and organization of Primary Health Care and financing. Results: Twelve studies that followed the research proposal were included. The systems shown are related to the countries: Iraq, Ecuador, Denmark, Argentina, Netherlands, Canada, Ireland, Belgium, France, Sweden, United Kingdom and Italy. Conclusion: Among the health systems and services of the analyzed countries, some are guided by the market model, others by the public offer of health care and there are those that integrate the two models. Health systems must offer services that reach the entire population, organized based on Primary Health Care. Those who adopt the social security model are the closest to this scenario. (AU)

Objetivo: Mapear, con base em la literatura, los sistemas y servicios de salud a nivel mundial, presentandolos em relación a su protección social, prestacion de los servicios de salud, estrutura organizacional y su fuente de financiamento. Caracterizar, con base en la literatura, los sistemas y servicios de salud a nivel mundial. Metodos: Esta es una revisión de alcance de las bases de datos: Biblioteca Virtual de Salud, Embase, ProQuest, Biblioteca Nacional de Medicina, Institutos Nacionales de Salud y Biblioteca Electrónica Científica en Línea. Se utilizaron los descriptores y sus combinaciones: Sistemas de Salud, Servicios de Salud, Estructura de Servicios y Atención Primaria de Salud, entre 2009 y 2019, disponibles en español, francés, inglés, portugués. Fueron analizados considerando: objetivos del estudio, tipo de protección social, prestación de servicios, estructura y organización de la Atención Primaria de Salud y financiamiento. Resultados: Se incluyeron doce estudios que se adhirieron a la propuesta de investigación. Los sistemas mostrados están relacionados con los países: Irak, Ecuador, Dinamarca, Argentina, Países Bajos, Canadá, Irlanda, Bélgica, Francia, Suecia, Reino Unido e Italia. Conclusion: Entre los sistemas y servicios de salud de los países analizados, algunos se guían por el modelo de mercado, otros por la oferta pública de atención en salud y existen los que integran los dos modelos. Los sistemas de salud deben ofrecer servicios que lleguen a toda la población, organizados en base a la Atención Primaria de Salud, quienes adoptan el modelo de seguridad social son los más cercanos a este escenario. (AU)

Sistemas de Saúde , Atenção Primária à Saúde , Estrutura dos Serviços , Serviços Básicos de Saúde
J Med Internet Res ; 23(9): e29839, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477556


BACKGROUND: Research on the integration of artificial intelligence (AI) into community-based primary health care (CBPHC) has highlighted several advantages and disadvantages in practice regarding, for example, facilitating diagnosis and disease management, as well as doubts concerning the unintended harmful effects of this integration. However, there is a lack of evidence about a comprehensive knowledge synthesis that could shed light on AI systems tested or implemented in CBPHC. OBJECTIVE: We intended to identify and evaluate published studies that have tested or implemented AI in CBPHC settings. METHODS: We conducted a systematic scoping review informed by an earlier study and the Joanna Briggs Institute (JBI) scoping review framework and reported the findings according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Reviews) reporting guidelines. An information specialist performed a comprehensive search from the date of inception until February 2020, in seven bibliographic databases: Cochrane Library, MEDLINE, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ScienceDirect, and IEEE Xplore. The selected studies considered all populations who provide and receive care in CBPHC settings, AI interventions that had been implemented, tested, or both, and assessed outcomes related to patients, health care providers, or CBPHC systems. Risk of bias was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Two authors independently screened the titles and abstracts of the identified records, read the selected full texts, and extracted data from the included studies using a validated extraction form. Disagreements were resolved by consensus, and if this was not possible, the opinion of a third reviewer was sought. A third reviewer also validated all the extracted data. RESULTS: We retrieved 22,113 documents. After the removal of duplicates, 16,870 documents were screened, and 90 peer-reviewed publications met our inclusion criteria. Machine learning (ML) (41/90, 45%), natural language processing (NLP) (24/90, 27%), and expert systems (17/90, 19%) were the most commonly studied AI interventions. These were primarily implemented for diagnosis, detection, or surveillance purposes. Neural networks (ie, convolutional neural networks and abductive networks) demonstrated the highest accuracy, considering the given database for the given clinical task. The risk of bias in diagnosis or prognosis studies was the lowest in the participant category (4/49, 4%) and the highest in the outcome category (22/49, 45%). CONCLUSIONS: We observed variabilities in reporting the participants, types of AI methods, analyses, and outcomes, and highlighted the large gap in the effective development and implementation of AI in CBPHC. Further studies are needed to efficiently guide the development and implementation of AI interventions in CBPHC settings.

Inteligência Artificial , Atenção Primária à Saúde , Serviços de Saúde Comunitária , Atenção à Saúde , Pessoal de Saúde , Humanos
Enferm. foco (Brasília) ; 12(2): 407-413, set. 2021. tab, ilus
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1291881


Objetivo: Identificar as experiências brasileiras no acompanhamento de crescimento e desenvolvimento infantil no contexto da Atenção Básica. Método: Trata-se de um estudo do tipo Revisão Integrativa de Literatura. As bases de dados utilizadas nesse estudo foram: Scientific Eletronic Library Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde e SCOPUS. Resultados: Durante a busca inicial foram encontrados setenta e oito artigos, onze artigos repetiam-se dentro das bases e por esse motivo, a amostra final foi composta por oito artigos. O acompanhamento do crescimento e desenvolvimento infantil é realizado por meio de consultas na ESF e, em sua maioria, com ações de aferição de medidas antropométricas, verificação do esquema vacinal e orientação nutricional. Conclusão: Foi possível identificar experiências de consultas que ainda estão voltadas para o modelo biomédico, pautado na queixa conduta. É preciso que os profissionais atuantes na Atenção Básica recebam capacitação de qualidade, para que suas ações sejam efetivas na prevenção e promoção de saúde infantil. (AU)

Objective: To identify the Brazilian experiences in monitoring growth and child development in the context of Primary Care. Methods: This is an Integrative Literature Review study. The databases used in this study were: Scientific Electronic Library Online, Latin American and Caribbean Health Sciences Literature and SCOPUS. Seventy-eight articles were found during the initial search, eleven articles were repeated within the bases and for this reason. The final sample of eight articles. Results: The monitoring of child growth and development is carried out through consultations in the FHS and, mostly, with actions of measurement of anthropometric measures, verification of the vaccination scheme and nutritional guidance. It was possible to identify consultation experiences that are still focused on the biomedical model, based on the conduct complaint. Conclusion: It is necessary that professionals working in Primary Care receive quality training, so that their actions are effective in the prevention and promotion of child health. (AU)

Objetivo: Identificar las experiencias brasileñas en el monitoreo del crecimiento y desarrollo infantil en el contexto de la Atención Primaria. Métodos: Este es un estudio de Revisión Integral de Literatura. Como base de datos utilizada en este estudio: Biblioteca científica electrónica en línea, Literatura latinoamericana y caribeña en ciencias de la salud y SCOPUS. Durante una búsqueda inicial, se encontraron setenta y ocho artículos, algunos artículos repetidos dentro de las bases y por esa razón. La muestra final fue de ocho artículos. Resultados: En caso de extracción de resultados, verifique si el monitoreo del crecimiento y desarrollo infantil se realiza a través de consultas en la FHS y, en la mayoría de los casos, con medidas para medir medidas antropométricas, verifique el calendario de vacunación y la guía nutricional. Conclusión: Fue posible identificar experiencias de consulta que todavía se centran en el modelo biomédico, basado en la queja de conducta. Es necesario que los profesionales que trabajan en Atención Primaria reciban capacitación de calidad, para que sus acciones sean efectivas en la prevención y promoción de la salud infantil. (AU)

Desenvolvimento Infantil , Atenção Primária à Saúde , Enfermagem , Assistência Integral à Saúde
Rev Colomb Psiquiatr (Engl Ed) ; 50 Suppl 1: 30-41, 2021 Jul.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34353780


INTRODUCTION: This systematic review summarises the existing evidence on the implementation of technology-based mental healthcare models in the primary care setting. METHODS: A systematic search was conducted (MEDLINE, Embase, CENTRAL) in August 2019 and studies were selected according to predefined eligibility criteria. The main outcomes were clinical effectiveness, adherence to primary treatment and cost of implementation. SELECTION CRITERIA: Studies with an experimental or quasi-experimental design that evaluated the implementation of technology-based mental healthcare models were included. RESULTS: Five articles met the inclusion criteria. The models included technological devices such as tablets, cellphones and computers, with programs and mobile apps that supported decision-making in the care pathway. These decisions took place at different times, from the universal screening phase to the follow-up of patients with specific conditions. In general, the studies showed a decrease in the reported symptoms. However, there was great heterogeneity in both the health conditions and the outcomes, which hindered a quantitative synthesis. The assessment of risk of bias showed low quality of evidence. CONCLUSION: There is not enough evidence to support the implementation of a technology-based mental healthcare model. High quality studies that focus on implementation and effectiveness outcomes are needed to evaluate the impact of technology-based mental healthcare models in the primary care setting.

Telefone Celular , Serviços de Saúde Mental , Viés , Humanos , Atenção Primária à Saúde , Tecnologia
Aust J Rural Health ; 29(4): 492-501, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34423514


OBJECTIVE: To describe effects of employing primary care doctors in hospital care and their roles in improving the quality of care and health outcomes of rural and remote patients. DESIGN: A systematic scoping review. SETTING: Peer-reviewed publications were sourced from 3 online journal databases (PUBMED, SCOPUS and Web of Science). PARTICIPANTS: All study designs from peer-reviewed journals that discussed effects of employing primary care doctors in hospital care Interventions: employing primary care doctors in hospital care. MAIN OUTCOME MEASURES: Positive and negative consequences of employing primary care doctors in hospital care, and the roles of primary care doctors in improving the quality of care and health outcomes. RESULTS: A total of 12 articles met the inclusion and exclusion criteria. Positive outcomes included improved access to specialised treatment, improved continuity of care, reduced waiting list and admission rates, improved skills, competence and confidence of primary care doctors, and increased satisfaction from both health providers and patients/families. Negative consequences reported included increased prescriptions and poorly documented history and physical examinations. CONCLUSION: Employing primary care doctors in hospital care can fill the gaps in the delivery of acute care, emergency medicine and maternity care. Primary care doctors bring advanced clinical skills and a patient-centred approach to the hospital care. They also improve the quality of referrals leading to freed-up clinical capacity of tertiary hospitals to treat more serious conditions. The provision of acute or emergency care and secondary care in rural and remote areas should be directed towards patient-oriented not provider-oriented policies.

Hospitais , Médicos de Atenção Primária , Qualidade da Assistência à Saúde , Serviços de Saúde Rural , Competência Clínica , Humanos , Avaliação de Resultados em Cuidados de Saúde , Assistência Centrada no Paciente , Atenção Primária à Saúde
BMC Pregnancy Childbirth ; 21(1): 573, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34416856


BACKGROUND: Currently, we suffer from an increasing diabetes pandemic and on the other hand from the SARS-CoV-2 pandemic. Already at the beginning of the SARS-CoV-2 pandemic, it was quickly assumed that certain groups are at increased risk to suffer from a severe course of COVID-19. There are serious concerns regarding potential adverse effects on maternal, fetal, and neonatal outcomes. Diabetic pregnancies clearly need special care, but clinical implications as well as the complex interplay of diabetes and SARS-CoV-2 are currently unknown. We summarized the evidence on SARS-CoV-2 in diabetic pregnancies, including the identification of novel potential pathophysiological mechanisms and interactions as well as clinical outcomes and features, screening, and management approaches. METHODS: We carried out a systematic scoping review in MEDLINE (PubMed), EMBASE, CINAHL, Cochrane Library, and Web of Science Core Collection in September 2020. RESULTS: We found that the prognosis of pregnant women with diabetes mellitus and COVID-19 may be associated with potential underlying mechanisms such as a simplified viral uptake by ACE2, a higher basal value of pro-inflammatory cytokines, being hypoxemic as well as platelet activation, embolism, and preeclampsia. In the context of "trans-generational programming" and COVID-19, life-long consequences may be "programmed" during gestation by pro-inflammation, hypoxia, over- or under-expression of transporters and enzymes, and epigenetic modifications based on changes in the intra-uterine milieu. COVID-19 may cause new onset diabetes mellitus, and that vertical transmission from mother to baby might be possible. CONCLUSIONS: Given the challenges in clinical management, the complex interplay between COVID-19 and diabetic pregnancies, evidence-based recommendations are urgently needed. Digital medicine is a future-oriented and effective approach in the context of clinical diabetes management. We anticipate our review to be a starting point to understand and analyze mechanisms and epidemiology to most effectively treat women with SARS-COV-2 and diabetes in pregnancy.

COVID-19/epidemiologia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Saúde Materna/estatística & dados numéricos , Complicações Infecciosas na Gravidez/epidemiologia , Gravidez em Diabéticas/epidemiologia , Cuidado Pré-Natal/métodos , Feminino , Humanos , Recém-Nascido , Gravidez , Prevenção Primária/métodos
Horiz. enferm ; 32(2): 192-211, 20210831. tab
Artigo em Espanhol | LILACS, BDENF - Enfermagem | ID: biblio-1290758


La salud escolar en Chile se desarrolla a nivel de la Atención Primaria en salud a cargo de los profesionales de enfermería, quienes por su rol deben velar por el bienestar integral de la comunidad escolar, fortaleciendo conductas de autocuidado y hábitos saludables a través de la promoción y prevención e investigación en salud. OBJETIVO: Analizar los beneficios del rol de enfermería en salud escolar desde el punto de vista político y social en países en que ha sido legalmente implementada a nivel internacional. MÉTODOS: Se realizó una revisión sistemática de la literatura científica en bases de datos (Scielo, Pubmed, Scopus, Sciencedirect, Oxford, Web of Science). Se utilizó el flujograma PRISMA. La calidad metodológica consideró los criterios de alto, medio y bajo cumplimiento de 46 indicadores de una pauta de lectura crítica. RESULTADOS: Se identificaron 32 artículos en los últimos 5 años. Las líneas temáticas encontradas fueron las políticas públicas en salud escolar, destacando países como EEUU, España y México con regulación sobre la Enfermera escolar, en cambio en Latinoamérica, existe una regulación parcial o carencia como en Chile. Las competencias y acciones del profesional de enfermería en establecimientos educacionales tienen como prioridad la promoción de la salud y la educación a la comunidad escolar. Se evidencia que las consultas que atiende la enfermera escolar son de urgencia y son variables según la zona geográfica. CONCLUSIONES: La implementación legal del rol de enfermería escolar ofrece ventajas significativas para la mejora del sistema sanitario del país, incrementando la calidad asistencial y mejorando el acceso a salud.

Chilean school health is developed at the level of Primary Health Care in charge of nursing professionals, who for their role must ensure the comprehensive well-being of the school community, strengthening self-care behaviors and healthy habits through promotion and prevention and health research. OBJECTIVE: To analyze the benefits of the nursing role in school health from the political and social point of view in countries where it has been legally implemented internationally. METHODS: A systematic review of the scientific literature in databases (Scielo, Pubmed, Scopus, Sciencedirect, Oxford, Web of Science) was carried out. The PRISMA flow chart was used. The methodological quality considered the criteria of high, medium and low compliance with 46 indicators of a critical reading pattern. RESULTS: 32 articles were identified in the last 5 years. The thematic lines found were public policies in school health, highlighting countries such as the US, Spain and Mexico with regulations on school nurses, on the other hand in Latin America, there is a partial regulation or lack as in Chile. The competences and actions of the nursing professional in educational establishments have as a priority the promotion of health and education to the school community. It is evident that the consultations attended by the school nurse are urgent and vary according to the geographical area. CONCLUSIONS: The legal implementation of the role of school nursing offers significant advantages for the improvement of the country's health system, increasing the quality of care and improving access to health.

Serviços de Saúde Escolar , Serviços de Enfermagem Escolar , Papel do Profissional de Enfermagem , Atenção Primária à Saúde , Qualidade da Assistência à Saúde , Chile , Enfermagem em Saúde Comunitária
Int J Nurs Stud ; 121: 103986, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34242979


BACKGROUND: Globally, chronic disease is a leading cause of illness, disability and death and an important driver of health system utilization and spending. Continuity of care is a significant component of quality healthcare. However, an association between nurse-led services, interventions, patient outcomes and continuity of care at the primary and secondary interface as an outcome, has not been established for people with chronic disease. OBJECTIVE: To identify the effectiveness of nurse-led services for people with chronic disease in achieving an outcome of continuity of care at the primary-secondary healthcare interface. DESIGN: Quantitative systematic review. DATA SOURCES: Systematic searches of Medline, Cochrane, Embase, Emcare, JBI and Scopus databases were conducted of studies published between 1946 and May 2019 using the search terms "nurse", "continuity of care" and "chronic disease". REVIEW METHODS: Quality of the included studies was assessed using the Cochrane risk of bias tool for randomized controlled trials and Joanna Briggs Institute quality appraisal checklists. A second reviewer screened 10% of full text articles and all articles in critical appraisal. Studies were excluded from the review if they were of poor methodological quality or the description of the effect of the nurse-led service was inadequately reported. RESULTS: Fourteen studies were included in the review (n=4,090 participants). All studies incorporated recognized continuity of care interventions. The nurse-led services were associated with fewer hospitalizations, reduced by 2-8.9% and re-admissions reduced by 14.8-51% (n=886). Reporting of positive patient experiences and improvement in symptoms and lifestyle was also evident. An association of nurse-led services with improved continuity of care between primary and secondary health services as an outcome per se could not be concluded. CONCLUSION: Nurse-led services for adults provide coordinated interventions that support continuity of care for people with chronic disease in both the primary and secondary healthcare settings that are associated with reduced hospitalizations or readmissions and patient satisfaction. However, the limited use of validated continuity of care outcome measurement tools precluded establishing correlations between interventions, patient outcomes and continuity of care as a specific outcome.

Papel do Profissional de Enfermagem , Atenção Primária à Saúde , Adulto , Doença Crônica , Continuidade da Assistência ao Paciente , Humanos , Satisfação do Paciente
Cochrane Database Syst Rev ; 7: CD010771, 2021 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-34278564


BACKGROUND: The IQCODE (Informant Questionnaire for Cognitive Decline in the Elderly) is a commonly used questionnaire based tool that uses collateral information to assess for cognitive decline and dementia. Brief tools that can be used for dementia "screening" or "triage" may have particular utility in primary care / general practice healthcare settings but only if they have suitable test accuracy. A synthesis of the available data regarding IQCODE accuracy in a primary care setting should help inform cognitive assessment strategies for clinical practice; research and policy. OBJECTIVES: To determine the accuracy of the informant-based questionnaire IQCODE, for detection of dementia in a primary care setting. SEARCH METHODS: A search was performed in the following sources on the 28th of January 2013: ALOIS (Cochrane Dementia and Cognitive Improvement Group), MEDLINE (Ovid SP), EMBASE (Ovid SP), PsycINFO (Ovid SP), BIOSIS (Ovid SP), ISI Web of Science and Conference Proceedings (ISI Web of Knowledge), CINHAL (EBSCOhost) and LILACs (BIREME). We also searched sources specific to diagnostic test accuracy: MEDION (Universities of Maastricht and Leuven); DARE (York University); HTA Database (Health Technology Assessments Database via The Cochrane Library) and ARIF (Birmingham University). We developed a sensitive search strategy; search terms were designed to cover key concepts using several different approaches run in parallel and included terms relating to cognitive tests, cognitive screening and dementia. We used standardized database subject headings such as MeSH terms (in MEDLINE) and other standardized headings (controlled vocabulary) in other databases, as appropriate. SELECTION CRITERIA: We selected those studies performed in primary care settings, which included (not necessarily exclusively) IQCODE to assess for the presence of dementia and where dementia diagnosis was confirmed with clinical assessment. For the "primary care" setting, we included those healthcare settings where unselected patients, present for initial, non-specialist assessment of memory or non-memory related symptoms; often with a view to onward referral for more definitive assessment. DATA COLLECTION AND ANALYSIS: We screened all titles generated by electronic database searches and abstracts of all potentially relevant studies were reviewed. Full papers were assessed for eligibility and data extracted by two independent assessors. Quality assessment (risk of bias and applicability) was determined using the QUADAS-2 tool. Reporting quality was determined using the STARDdem extension to the STARD tool. MAIN RESULTS: From 71 papers describing IQCODE test accuracy, we included 1 paper, representing data from 230 individuals (n=16 [7%] with dementia). The paper described those patients consulting a primary care service who self-identified as Japanese-American. Dementia diagnosis was made using Benson & Cummings criteria and the IQCODE was recorded as part of a longer interview with the informant. IQCODE accuracy was assessed at various test thresholds, with a "trade-off" between sensitivity and specificity across these cutpoints. At an IQCODE threshold of 3.2 sensitivity: 100%, specificity: 76%; for IQCODE 3.7 sensitivity: 75%, specificity: 98%. Applying the QUADAS-2 assessments, the study was at high risk of bias in all categories. In particular degree of blinding was unclear and not all participants were included in the final analysis. AUTHORS' CONCLUSIONS: It is not possible to give definitive guidance on the test accuracy of IQCODE for the diagnosis of dementia in a primary care setting based on the single study identified. We are surprised by the lack of research using the IQCODE in primary care as this is, arguably, the most appropriate setting for targeted case finding of those with undiagnosed dementia in order to maximise opportunities to intervene and provide support for the individual and their carers.

Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Família , Amigos , Medicina Geral , Inquéritos Epidemiológicos/normas , Americanos Asiáticos , Humanos , Japão/etnologia , Atenção Primária à Saúde , Sensibilidade e Especificidade , Estados Unidos
Inquiry ; 58: 469580211028579, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34275346


Governance has been highlighted as an important building block underpinning the process of mental health integration into primary healthcare. This qualitative systematic review aims to identify the governance issues faced by countries in the Sub-Saharan Africa and South Asia Region in the implementation of integrated primary mental healthcare. PRISMA guideline was used to conduct a systematic search of relevant studies from 4 online databases that were filtered according to inclusion and exclusion criteria. Using the Critical Appraisal Skills Program (CASP) Qualitative Checklist, a quality appraisal of the selected articles was performed. By drawing upon institutional theory, data was extracted based on a pre-constructed matrix. The CERQual approach synthesized evidence and rank confidence level as low, moderate or high for 5 key findings. From 567 references identified, a total of 8 studies were included. Respondents were policymakers or implementers involved in integrated primary mental healthcare from the national, state, and district level. Overall, the main governance issues identified were a lack of leadership and mental health prioritization; inadequate financing and human resource capacity; and negative mental health perceptions/attitudes. The implication of the findings is that such issues must be addressed for long-term health system performance. This can also improve policymaking for better integration of primary mental health services into the health systems of countries in the Sub-Saharan and South Asia region.

Serviços de Saúde Mental , África ao Sul do Saara , Ásia , Programas Governamentais , Humanos , Atenção Primária à Saúde
BMC Health Serv Res ; 21(1): 644, 2021 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217265


BACKGROUND: Symptom recognition and timely referral in primary care are crucial for the early diagnosis of cancer. Physician assistants or associates (PAs) have been introduced in 18 healthcare systems across the world, with numbers increasing in some cases to address primary care physician shortages. Little is known about their impact on suspected cancer recognition and referral. This review sought to summarise findings from observational studies conducted in high income countries on PAs' competence and performance on processes concerned with the quality of recognition and referral of suspected cancer in primary care. METHOD: A rapid systematic review of international peer-reviewed literature was performed. Searches were undertaken on OVID, EMBASE, Web of Science, and CINAHL databases (2009-2019). Studies were eligible if they reported on PA skills, processes and outcomes relevant to suspected cancer recognition and referral. Title and abstract screening was followed by full paper review and data extraction. Synthesis of qualitative and quantitative findings was undertaken on three themes: deployment, competence, and performance. Preliminary findings were discussed with an expert advisory group to inform interpretation. RESULTS: From 883 references, 15 eligible papers were identified, of which 13 were from the USA. Seven studies reported on general clinical processes in primary care that would support cancer diagnosis, most commonly ordering of diagnostic tests (n = 6) and referrals to specialists (n = 4). Fewer papers reported on consultation processes, such as examinations or history taking (n = 3) Six papers considered PAs' competence and performance on cancer screening. PAs performed similarly to primary care physicians on rates of diagnostic tests ordered, referrals and patient outcomes (satisfaction, malpractice, emergency visits). No studies reported on the timeliness of cancer diagnosis. CONCLUSION: This review of peer-reviewed literature combined with advisory group interpretation suggests the introduction of PAs into primary care may maintain the quality of referrals and diagnostic tests needed to support cancer diagnosis. It also highlights the lack of research on several aspects of PAs' roles, including outcomes of the diagnostic process.

Neoplasias , Assistentes Médicos , Médicos , Humanos , Atenção Primária à Saúde , Encaminhamento e Consulta , Especialização
Cochrane Database Syst Rev ; 7: CD012944, 2021 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-34314020


BACKGROUND: The ubiquity of mobile devices has made it possible for clinical decision-support systems (CDSS) to become available to healthcare providers on handheld devices at the point-of-care, including in low- and middle-income countries. The use of CDSS by providers can potentially improve adherence to treatment protocols and patient outcomes. However, the evidence on the effect of the use of CDSS on mobile devices needs to be synthesized. This review was carried out to support a World Health Organization (WHO) guideline that aimed to inform investments on the use of decision-support tools on digital devices to strengthen primary healthcare. OBJECTIVES: To assess the effects of digital clinical decision-support systems (CDSS) accessible via mobile devices by primary healthcare providers in the context of primary care settings. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, Global Index Medicus, POPLINE, and two trial registries from 1 January 2000 to 9 October 2020. We conducted a grey literature search using and issued a call for papers through popular digital health communities of practice. Finally, we conducted citation searches of included studies. SELECTION CRITERIA: Study design: we included randomized trials, including full-text studies, conference abstracts, and unpublished data irrespective of publication status or language of publication.  Types of participants: we included studies of all cadres of healthcare providers, including lay health workers and other individuals (administrative, managerial, and supervisory staff) involved in the delivery of primary healthcare services using clinical decision-support tools; and studies of clients or patients receiving care from primary healthcare providers using digital decision-support tools. Types of interventions: we included studies comparing digital CDSS accessible via mobile devices with non-digital CDSS or no intervention, in the context of primary care. CDSS could include clinical protocols, checklists, and other job-aids which supported risk prioritization of patients. Mobile devices included mobile phones of any type (but not analogue landline telephones), as well as tablets, personal digital assistants, and smartphones. We excluded studies where digital CDSS were used on laptops or integrated with electronic medical records or other types of longitudinal tracking of clients. DATA COLLECTION AND ANALYSIS: A machine learning classifier that gave each record a probability score of being a randomized trial screened all search results. Two review authors screened titles and abstracts of studies with more than 10% probability of being a randomized trial, and one review author screened those with less than 10% probability of being a randomized trial. We followed standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care group. We used the GRADE approach to assess the certainty of the evidence for the most important outcomes. MAIN RESULTS: Eight randomized trials across varying healthcare contexts in the USA,. India, China, Guatemala, Ghana, and Kenya, met our inclusion criteria. A range of healthcare providers (facility and community-based, formally trained, and lay workers) used digital CDSS. Care was provided for the management of specific conditions such as cardiovascular disease, gastrointestinal risk assessment, and maternal and child health. The certainty of evidence ranged from very low to moderate, and we often downgraded evidence for risk of bias and imprecision. We are uncertain of the effect of this intervention on providers' adherence to recommended practice due to the very low certainty evidence (2 studies, 185 participants). The effect of the intervention on patients' and clients' health behaviours such as smoking and treatment adherence is mixed, with substantial variation across outcomes for similar types of behaviour (2 studies, 2262 participants). The intervention probably makes little or no difference to smoking rates among people at risk of cardiovascular disease but probably increases other types of desired behaviour among patients, such as adherence to treatment. The effect of the intervention on patients'/clients' health status and well-being  is also mixed (5 studies, 69,767 participants). It probably makes little or no difference to some types of health outcomes, but we are uncertain about other health outcomes, including maternal and neonatal deaths, due to very low-certainty evidence. The intervention may slightly improve patient or client acceptability and satisfaction (1 study, 187 participants). We found no studies that reported the time between the presentation of an illness and appropriate management, provider acceptability or satisfaction, resource use, or unintended consequences. AUTHORS' CONCLUSIONS: We are uncertain about the effectiveness of mobile phone-based decision-support tools on several outcomes, including adherence to recommended practice. None of the studies had a quality of care framework and focused only on specific health areas.   We need well-designed research that takes a systems lens to assess these issues.

Telefone Celular , Sistemas de Apoio a Decisões Clínicas , Atenção Primária à Saúde , Melhoria de Qualidade , Qualidade da Assistência à Saúde , Viés , Fidelidade a Diretrizes , Guias como Assunto , Comportamentos Relacionados com a Saúde , Pessoal de Saúde , Nível de Saúde , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
J Glob Health ; 11: 11001, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34327001


Background: The effectiveness of community-based primary health care (CBPHC) interventions in low- and middle-income countries (LMICs), especially for maternal, neonatal and child health, is well established. However, there has not been a systematic review of the literature on the effectiveness of CBPHC on HIV outcomes derived from rigorous assessments of primary studies. Using peer-reviewed studies of randomized interventions or those containing a specified control group and directly measuring clinical HIV outcomes, we provide evidence for the effectiveness of CBPHC on HIV outcomes for mothers and children in low- and middle-income countries (LMICs). Methods: Eligibility criteria included studies assessing the effectiveness of community-based HIV interventions with or without a facility-based component, or multiple integrated projects, with outcome measures defining an aspect of HIV health status such as the utilization of prevention or health care services, nutritional status, serious morbidity (including clinical measures of HIV progression) or mortality of children aged five or younger and pregnant women. Articles published through June 3, 2020 were identified by searching four databases. The type of community-based projects implemented, the implementors, and the implementation strategies of each program were identified and the impact on HIV-related outcomes assessed. Results: The search yielded 10 537 articles; 4881 underwent title and abstract screening after removing duplicates. Of these, 117 studies qualified for full-text screening; only 22 were included in the final analysis. Most studies showed that community-based interventions improved HIV prevention and treatment outcomes compared to facility-based approaches alone. Each study had at least one statistically significant HIV-related outcome; the non-significant outcomes found in six of the 22 studies were mostly not related to HIV programming. Most interventions were implemented by community health workers; other implementers were government workers, community members, or research staff. Strategies used included peer-to-peer education, psychosocial support, training of community champions, community-based follow-up care, home-based care, and integrated care. Conclusions: CBPHC strategies are effective in improving population-based, HIV-related health outcomes for mothers and children, especially in combination with facility-based approaches. However, there is a need to assess the scalability of such interventions and integrate them into existing health systems to assess their impact on the HIV pandemic in more routine settings.

Serviços de Saúde Comunitária , Infecções por HIV , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez , Atenção Primária à Saúde , Países em Desenvolvimento , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
J Am Geriatr Soc ; 69(10): 2963-2972, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34247383


BACKGROUND: Although more than seven million older adults struggle or are unable to leave their homes independently, only a small minority access home-based primary care (HBPC). Despite substantial growth of HBPC, fueled by growing evidence supporting positive patient outcomes and cost savings, the population remains dramatically underserved and many evidence gaps still exist around scope of practice and key issues in care delivery and quality. Understanding the current state of the field is critical to the delivery of high-quality home-based care. METHODS: We conducted a systematic search of the peer-reviewed literature on HBPC, published between January 2010 and January 2020, using Medline, CINAHL, Embase, Web of Science, and Scopus online libraries. All studies were evaluated by two members of the research team, and key findings were extracted. RESULTS: The initial search yielded 1730 unique studies for screening. Of these initial results, 1322 were deemed not relevant to this review. Of the 408 studies deemed potentially relevant, 79 were included in the study. Researchers identified five overarching themes: the provision of HBPC, the composition of care teams, HBPC outcomes, the role of telehealth, and emergency preparedness efforts. CONCLUSION: The need and desire for growth of HBPC has been highlighted by the recent COVID-19 pandemic. Current research on HBPC finds a diverse scope of practice, successful use of interdisciplinary teams, positive outcomes, and increasing interest in telehealth with many areas ripe for further research.

COVID-19 , Defesa Civil/normas , Atenção à Saúde/normas , Serviços de Assistência Domiciliar , Atenção Primária à Saúde , Telemedicina , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Necessidades e Demandas de Serviços de Saúde , Serviços de Assistência Domiciliar/organização & administração , Serviços de Assistência Domiciliar/normas , Serviços de Assistência Domiciliar/tendências , Humanos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Lacunas da Prática Profissional , SARS-CoV-2 , Telemedicina/métodos , Telemedicina/tendências , Estados Unidos