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Developing primary health care.

Primary health care is best provided by a primary health care team of general practitioners, community nurses, and other staff working together from good premises and looking after the population registered with the practice. It encourages personal and continuing care of patients and good communication among the members of the team. Efforts should be made to foster this model of primary care where possible and also to evaluate its effectiveness. Community services that are not provided by primary care teams should be organised on a defined geographical basis, and the boundaries of these services should coincide as much as possible. Such arrangements would facilitate effective community care and health promotion and can be organised to work well with primary care teams. The patient's right to freedom of choice of a doctor, however, should be retained, as it adds flexibility to the rigidity of fixed geographically based services.

Community Health Nursing↗

Patient-number-based computerized medical records in Crete. A tool for planning and assessment of primary health care.

Primary Health Care (PHC) in Crete is in a state of rapid development. The strategy for introducing PHC involves an orientation towards the population and the creation of possibilities for evaluation. A case records system, "Egino", was installed in the University of Heraklion and at the Health Centre in Spili in 1988, and was further developed according to local needs during 1989, when also a Greek version of the statistical system, "DoIt", was installed. The main reasons for establishing a computerized medical information system were (i) to assess the health needs in Crete, (ii) to monitor activities of the primary health care organizations, and (iii) to introduce epidemiological research into primary health care in Greece. The information system was based on specially assigned patient numbers containing several pieces of information about the individual; the system was developed at the Dalby Health Sciences Centre in Sweden. Each month, data were extracted in Spili Health Centre, and these data were regularly used to present incidence and prevalence indices. Some of the data extracted were reported to the health authorities in Greece. "EginO" and "DoIt" gave possibilities to evaluate health services by following the morbidity, while also making it possible to describe and analyse health needs in the population of Spili and other primary health care catchment areas in Greece.

Adolescent↗

An overview of primary health care.

Primary health care has become a focus of interest from the World Health Organization down. The hopes that more emphasis on primary care will lead to less expensive and better care will not be realized unless a more critical analysis of its problems is undertaken and some of its defects and deficiencies put right. Its roles must be better defined and the work shared within a team; training and education must be more related to its needs; and much sharper research is required to decide what is useful and what is useless.

Community Health Services↗

Primary health care.

Primary Health Care (PHC) has been promulgated for over two decades as a global strategy for ensuring basic health care for all people. PHC is characterized by equity, accessibility, availability of resources, social participation, intersectoral community action, and cultural sensitivity. While PHC can be discussed as philosophy or a process, it is critical that PHC be understood as a community focus in health care that differs from a primary care focus on individuals. Capturing PHC components in community-based interventions in order to advance the development of a rigorous research base requires a shift in thinking about what constitutes acceptable methods and evidence for evaluating changes in health care. To this end, the authors of this review discuss perspectives and available research that inform practice within multidisciplinary teams, highlight the importance of social discourse, and review participatory evaluation issues for achieving a working relationship with communities. Particular attention is focused on education for nurses' roles in PHC activities within implementation models fostering community mobilization and development. An action plan is suggested as a means for situating discrete research activity within a PHC framework.

Education, Nursing↗

Problem behaviour in primary health care.

Primary health care can be regarded as the boundary between society as a whole and the medical system. Many of the problems patients bring to doctors in primary care are concerned with their personalities and life situation, and can be considered together as problems of human behaviour.On being questioned in a waiting room, 15 per cent of patients considered their problem "psychosocial only", and an additional 13 to 14 per cent "both somatic and psychosocial".I believe that the concept of the primary health care team is particularly valuable in managing problems of behaviour, and nondoctor members of the team play a crucial role.In my opinion it is questionable whether people's life problems should be channelled through primary health care, but in the meanwhile it seems clear that in most western societies the fact is they are.

Behavior↗

An assessment of the Cardiovascular Health Education Program in primary health care.

Primary health care is an effective means of improving health for all while at the same time containing rising health care costs. In an effort to improve the health of one community, the Cardiovascular Health Education Program (CHEP) was implemented in a study of 44 eighth-grade adolescents. The purpose of this study was to assess the influence of the CHEP on adolescents' cardiovascular health knowledge. It was found that participants' knowledge improved significantly, whereas a control group showed no comparable improvement. This study showed that community-based health education programs for targeted populations can influence health knowledge.

Adolescent↗

[Health care for the children population in Asturias based on levels and health care areas. Primary health care].

The resources available to the public health network in Asturias are presented for each health area in the level of pediatric primary care. Demographic analysis, age distribution and density of the ageing index for health areas are reported. In addition, the coverage, the number of families and children of care per physician, the rate of children per family, the care demand and the frequentation are evaluated. Imbalances are disclosed between the health centers and the outpatients clinics and between the health areas. The most important changes to be effected are pointed out.

Adolescent↗

[Result of a CPP-project at a primary health care center. Diabetes care in primary health care is resource-demanding].

Cost Per Patient (CPP) is a method to calculate health care costs for every individual health care contact. The method, which supplies information about diagnosis-related health care consumption, and was employed at the Primary Health Care Centre of Odeshög, Sweden. The study was conducted during 2001 and showed that 2% of the patients who had at least one contact with the health care centre were consuming 20% of the center's total resources. Furthermore, the single highest healthcare consumption was noted among the group of diabetic patients, mainly due to associated illness and the need for home care among those who were unable to manage their insulin injections themselves.

Community Health Centers↗

Primary health care: a preferred health service delivery option for women.

It is well known that gender is a determinant of health, but less understood is whether differences in health status attributable to gender can be mitigated through the implementation of primary health care. Primary health care, notably distinct from primary care, refers to a wide-ranging approach to the delivery of a comprehensive variety of health services. This article traces the similarities between primary health care and women-centred care from their overlapping philosophical foundations to the similar health, social, and economic benefits of both approaches. It is argued that investments in primary health care positively impact women's health, and, as such, should be a preferred option for the delivery of women's community health services. Several models of health service delivery that operate in accordance with principles of primary health care and also address the key tenets of women's-centred care are examined and their merits are compared. The article also identifies the major impediments to the adoption of both primary health care and women's-centred care approaches.

Canada↗

Why health improves: defining the issues concerning 'comprehensive primary health care' and 'selective primary health care'.

What is the impact of technology on improving the life situations of people, especially the poor? How is this impact analyzed in terms of health improvements? These questions are paramount in the minds of health planners as they pursue national policies of primary health care, a policy popularized by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) and accepted by over 150 governments at Alma Ata in 1978. The purpose of this paper is to explore these questions in depth. It begins by giving the background to the debate, then examines the origins of two concepts which have dominated the field, those of 'primary health care' and 'selective primary health care.' On this basis it suggests areas of differences in the two concepts and discusses the policy and practical implications of confusing the two approaches. The paper suggests that the differences are firstly who controls the outcome of technological interventions and the perceived time frame in which plans can be carried out.

Health Policy↗

The implementation of a diarrheal disease control program in Honduras: is it 'selective primary health care' or 'integrated primary health care'?

International public health scientists have debated the distinction of selective and integrated primary health care since the development of new selective primary health care interventions such as the Expanded Programme on Immunizations and the Diarrhoeal Disease Control Programme of the World Health Organization were developed. This paper argues that the codification offered by the identification of two incompatible paradigms is not a productive one for describing the implementation of national-level primary health care programs. This paper will explore these concerns by reviewing case materials of the implementation of a diarrheal diseases control program in Honduras.

Diarrhea↗

The origins of primary health care and selective primary health care.

I present a historical study of the role played by the World Health Organization and UNICEF in the emergence and diffusion of the concept of primary health care during the late 1970s and early 1980s. I have analyzed these organizations' political context, their leaders, the methodologies and technologies associated with the primary health care perspective, and the debates on the meaning of primary health care. These debates led to the development of an alternative, more restricted approach, known as selective primary health care. My study examined library and archival sources; I cite examples from Latin America.

History, 20th Century↗