Primary Health Care
Filter articles by Today's articles This week's articles Most viewed Most downloaded All
ARTICLE | doi:10.20944/preprints202306.0319.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: Pneumocystis pneumonia; immune status; real-time PCR; staining methods
Online: 5 June 2023 (12:55:05 CEST)
Background: Pneumocystis pneumonia (PCP) commonly affects immunocompromised individuals, whereas in immunocompetent persons, it occurs relatively rarely, and in most cases the Pneumocystis infection is detected as an asymptomatic colonization. The present study aimed to establish the prevalence of Pneumocystis jirovecii infection in human hosts with different immune status (immunocompromised and immunocompetent), using molecular diagnostic methods, and to compare their diagnostic value with that of classical staining methods. Methods: We used the collected to this moment data from a prospective study on the prevalence of pneumocystosis among the Bulgarian population. Clinical specimens (including throat secretion, induced sputum, tracheal aspirate, and bronchoalveolar lavage collected from 220 patients suspected of PCP (153 immunocompetent and 67 immunocompromised patients) were examined with staining microscopic methods and real-time PCR for detection of P. jirovecii. Results: DNA of the pathogen was detected in 38 (17%) specimens (32 immunocompromised patients and 6 immunocompetent subjects). From all 220 clinical samples examined by staining methods, only in five (2%) P. jirovecii cysts were detected by the Gomori's stain. All patients with PCP were treated with trimethoprim-sulfamethoxazole, but in ten of them (HIV- positive patients) the disease was with fatal outcome. Conclusions: This study is the first for the country including the main available laboratory methods for diagnosis of human pneumocystosis in Bulgaria. Regarding the etiological diagnosis of PCP, in our study the sensitivity of real-time PCR was higher compared to the staining methods. The choice of a method for sample collection and examination has an important role in the efficiency of the laboratory diagnostics.
ARTICLE | doi:10.20944/preprints202306.0316.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: primary care; grievances; complaints; satisfaction
Online: 5 June 2023 (12:04:49 CEST)
Primary Health Care is crucial in the healthcare system, being the first level of contact with health services for users and patients to take action using the available resources. Patient care units are created to facilitate direct user participation through the circuit of complaints, grievances, and suggestions, allowing the analysis of the population's unmet expectations and needs. To study complaints and grievances regarding the treatment and information received by users in the Santiago and Barbanza healthcare area during the year 2022. A descriptive cross-sectional study was conducted, in which complaints filed by patients in the year 2022 in the Santiago and Barbanza healthcare area were analyzed. A total of 326 users who filed a total of 512 complaints were studied in the year 2022, with 358 (70.0%) related to treatment/information. The mean age was 33.5±16.2 years. 72.4% were women (n=236). A Pearson correlation was performed to establish whether there was a dependence between the number of healthcare visits in both primary care and hospital settings in 2022 and the number of complaints filed in the same year. Pearson correlation coefficient was 0.14; 95% CI (0.02 - 0.27), p=0.012. There is a correlation between the number of consultations and the number of complaints filed. Frequent users are more likely to file a complaint. However, there is no correlation between the number of consultations and the likelihood of filing a complaint regarding treatment/information. Therefore, there seems to be a good relationship between healthcare personnel and users, which impacts patient satisfaction.
DATA DESCRIPTOR | doi:10.20944/preprints202306.0237.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: retina; swept-source; optical coherence tomography-angiography; OCT-A; cardiovascular risk; CHA2DS2-VASc
Online: 5 June 2023 (04:46:25 CEST)
In a context of exponential demographic growth, the imbalance between human resources and public health problems is impelling us to envision other solutions to the difficulties faced in the diagnosis, prevention and large-scale management of the most common diseases. Cardiovascular diseases represent the leading cause of morbidity and mortality worldwide. A large-scale screening program would make it possible to promptly identify patients with high cardiovascular risk in order to manage them adequately. Optical coherence tomography-angiography (OCT-A), as a window into the state of the cardiovascular system, is a rapid, reliable, and reproducible imaging examination that enables prompt identification of at-risk patients through the use of automated classification models. One challenge that limits the development of computer-aided diagnostic programs is the small number of open-source OCT-A acquisitions available. To facilitate the development of such models, we have assembled a set of images of the retinal microvascular system from 499 patients. It consists of 814 angiocubes as well as 2005 en face images. Angiocubes were captured with a swept-source OCT-A device of patients with varying overall cardiovascular risk. To the best of our knowledge, our dataset, RASTA, is the only publicly available dataset comprising such a variety of images from healthy and at-risk patients. This dataset will enable the development of generalizable models for screening of cardiovascular diseases from OCT-A retinal images.
Thu, 1 June 2023
REVIEW | doi:10.20944/preprints202306.0080.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: Type 1 Diabetes mellitus; Insulin; Diabetes management; Technology; Continuous glucose monitoring systems; Insulin pumps
Online: 1 June 2023 (11:07:07 CEST)
Type 1 Diabetes mellitus (T1DM) occurs when insulin is not produced in the Pancreas due to the autoimmune destruction of the beta cells. The patients may be diagnosed after 80-90% of the beta cells are destroyed. Insulin remains the essential medicine in T1DM management, under continuous monitoring of glucose levels. T1DM management consists of a complex and precise set of self-care measures for the entire life; during this continuous process, the patients could become overwhelmed, angry, anxious, frustrated, and/or discouraged. Therefore, to be widely used and provide general benefits, new technologies for DM management must provide clinical advantages without compromising safety. The compliance of T1DM patients is also essential, thus improving their quality of life (QoL). Moreover, the accessibility of the new system for patients through healthcare coverage is critical; they must be able to buy the new devices and accessories and pay for their maintenance. In this context, our work aims to describe the most recent technologies regarding continuous glucose monitors (CGMs) and continuous subcutaneous insulin infusion (CSII) systems, correlated with psychosocial impact and capacity to improve T1DM patients' life quality.
ARTICLE | doi:10.20944/preprints202306.0035.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: patients with oral cancer; LINE official account; oncological case management; interdisciplinary team; SDG “Good Health and Well-being”
Online: 1 June 2023 (05:14:11 CEST)
Background: Cancer patients require cross-professional care during the diagnosis and treatment periods. Therefore, methods for effectively carrying out case management are essential to tumor care. Purpose: To investigate the effects of using the community software LINE Official Ac-count on oral cancer case management. Methods: An experimental design was used; 100 patients were randomly divided into two groups by using a computer-generated random number table. The experimental group used LINE Official Account, which gave them self-care information, timely messages, and one-on-one health-care consultations. The control group followed standard healthcare practices. Results: The experimental group was satisfied with the self-care information provided by LINE Official Account (86.9%), patients regularly checked the self-care information (89.4%) and would check the information when receiving a push notification (54.3%). Ten patients used the one-on-one consultation(20.0%). LINE Official Account had a significant effect on the rate of participation in support groups. Generalized estimating equations indicated a significant difference between the two groups regarding the overall quality of life over 7 days (P = 0.023). Conclusion: Community software applications used in oncological case management can improve self-management and empower, also enable tracking of long-term follow-up effectiveness and reinforce the case manager’s role as a family therapist. Therefore, this study recommends that case manager systems be incorporated into mobile applications to increase the sustainable management, accessibility, effectiveness, and satisfaction of oncological management systems. This study also provides the value of Sustainable Development Goals (SDGs) with Good Health and Well-being, and decreased social withdrawal among patients with oral cancer.
Fri, 19 May 2023
ARTICLE | doi:10.20944/preprints202305.1441.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: Vaccine hesitancy; Vaccination, COVID-19; Predictors; Prevalence; Health workers
Online: 19 May 2023 (11:58:06 CEST)
Introduction: COVID-19 vaccines have been the most effective means in curbing the infection, however, vaccine hesitancy has been seen as a threat to global health. Objective: the study aimed to assess the prevalence and predictors of COVID-19 vaccine hesitancy among healthcare workers in infectious disease centers in Ghana. Method: A cross-sectional study and proportionate stratified sampling method was used to recruit participants from various infectious disease centers. Result: data from 170 participants were analyzed, revealing a low prevalence of COVID-19 vaccine hesitancy (11.2%) among healthcare workers. However, only 31.1% of the fully vaccinated participants had taken the booster dose. Factors such as concerns about vaccine safety and side effects from previous doses, indecisiveness, a lack of time to receive the vaccine and lack of access to accurate information, prefered natural immunity were the significant predictors of vaccine hesitancy among healthcare workers. Participants with good perception of the risk posed by COVID-19 was positively correlated with COVID-19 vaccine acceptance. Conclusion: the study suggests that policies should be enacted to ensure health workers are vaccinated against highly contagious infectious diseases to prevent their spread among the general population. Training and health promotion campaigns should also be organized to encourage healthcare workers to accept and patronize the vaccines.
Tue, 9 May 2023
REVIEW | doi:10.20944/preprints202305.0671.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: physical activity; counseling; primary health care
Online: 9 May 2023 (14:53:26 CEST)
Background: To identify and appraise the impacts and effectiveness of counseling interventions based on the 5A model on indicators of physical activity in adults. Methods: In May, 2022, a systematic review was carried out. Searches were performed in Embase, Lilacs, Pubmed, Scielo, Scopus, Sportdiscus and Web of Science. To avoid potential losses searches also were made in Google Scholar and in reference lists. Assessment of studies, data extraction and synthesis took place independently by two researchers. Results: Four studies composed the synthesis, which involved people with an average age between 40 and 55 years, being women in the majority of the samples. It was observed that counseling was carried out in conjunction with other strategies, such as drawing up an action plan, sending text messages and offering educational material. Only one study showed a statistically significant difference between the intervention and control groups in the “daily number of steps” indicator. Conclusions: counseling based on the 5A model did not reflect significant findings in relation to physical activity. Considering that behavior change for many people is neither a simple nor a quick process and that the 5A model is promising for other behavioral indicators, we indicate the need to carry out new intervention studies, with an expanded focus in relation to themes related to physical activity (e.g., types, dos-es, risks, benefits, identification of barriers and assessment) and, in parallel, the offer of practices in the Primary Health Care setting.
ARTICLE | doi:10.20944/preprints202305.0559.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: Pneumonia; Amoxicillin; Randomized Trial; Antimicrobial-Resistance.
Online: 9 May 2023 (04:12:01 CEST)
Pneumonia kills over two million children under-age of five every year. Oral amoxicillin was recommended by WHO as the first drug of choice for treatment of non-severe pneumonia. The study aimed to determine the clinical failure rate of amoxycillin for the treatment of childhood non-severe pneumonia at Primary Health Care Centers (PHCCs). A randomized controlled multicenter-trial study was conducted in Sana’a. IMCI strategy was used to enrollments the cases where randomly allocated to receive amoxicillin or co-trimoxazole orally for five days. Multivariate logistic regression was used for identified risk factors associated with clinical failure. A total of 254 children were enrolled, of whom 128 cases were treated with amoxicillin while 126 with co-trimoxazole. The clinical failure for amoxicillin was significantly more than co-trimoxazole (30% vs 10%) p value > 0.001. the most risk factor which significantly associated to amoxicillin failure were pre-infection in the last 6 months, while abnormal CBC and literate mothers were associated with clinical failure of co-trimoxazole (p value > 0.05). The use of co-trimoxazole as an alternative to amoxicillin for the treatment of non-severe pneumonia in the PHCCs and conducting further studies to determine the appropriate antibiotic as the first line of defense are recommended.
Sat, 6 May 2023
ARTICLE | doi:10.20944/preprints202305.0380.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: Return visit; elder; emergency department; triage risk screening tool; discharge planning
Online: 6 May 2023 (05:19:28 CEST)
Elders have a higher rate of return visits to the emergency department (ED) than other patients. It is critical to understand the risk factors for return visits to the ED by elders. The aim of this study was to determine the factors associated with return visits to the ED by elders. This study retrospectively reviewed the hospital charts of elders who return visits to the ED within 72 hours after discharge. The risk factors identified in the Triage Risk Screening Tool were applied in this study. Of the elders discharged from the ED, 8.64% made a return visit to the ED within 72 hours. The highest revisit rate occurred within 24 hours after discharge. Factors associated with return ED visits within 24 hours by elders were difficulty walking and having discharge care needs. Factors associated with ED return visits within 24–48 hours were cognitive impairment and polypharmacy. Difficulty walking, having discharge care needs and hospitalization within the past 120 days were associated with return visits made within 48–72 hours following discharge. Identifying the reasons for return visits to the ED and providing a continuous review of geriatric assessment and discharge planning could reduce unnecessary revisits.
Thu, 4 May 2023
ARTICLE | doi:10.20944/preprints202305.0259.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: prediction; risk factors; falls risk; Muslim; community-dwelling; elders; Pakistan
Online: 4 May 2023 (10:38:49 CEST)
Falls are the third-leading cause of disabilities among the elderly population worldwide. In Pakistan, the prevalence is 44%; out of them, 8% develop injuries, placing them at high risk for hospitalization or even premature death. Interestingly, fall is multifactorial, and fall risk depends on individual characteristics (intrinsic factors) and environmental features (extrinsic factors), which can be different from context to context. Therefore, regular assessment of fall risk factors is required to develop a strategy for fall prevention. This study aimed to identify intrinsic risk factors for falls in Pakistani elders living in the communities, and provide evidence for preventive strategies of falls in elderlies. Data were collected from 140 Muslim elders from two residential areas of Peshawar, Khyber Pakhtunkhwa, from July 2022 to August 25, 2022, after taking permission from Zhengzhou University Ethical Review Board (ZUIRB #202254), and District Health Department Office (DHO #14207).Participants were informed and concern was taken before collect data. Data were collected using the Time Up and Go Test (TUGT), the Mini-Mental Status Examination, and interviews regarding the prayer practice. Factors associated with falls were; age, gender, education, cognitive status, TUGT level, incorrect prayer postures, poor vision, and history of falls with a significance of (P.<0.05). Poor cognition, low vision, poor walking speed, and prayers without body movements have good membership with falls risk prediction as (P<0.005) in Omnibus, Lemeshow score (0.77). Hence, our study provides a road map for future risk assessment for falls by adding the four mentioned risk factors as offered in the proposed model to facilitate taking timely action to prevent fall-related ailments in Pakistani elders.
Wed, 26 April 2023
ARTICLE | doi:10.20944/preprints202304.0993.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: COVID-19 pandemic; routine immunization programs; service delivery; Northern Nigeria
Online: 26 April 2023 (13:05:16 CEST)
This study aimed to evaluate the impact of the COVID-19 pandemic on routine immunization (RI) programs in six Northern Nigerian states: Bauchi, Borno, Kaduna, Kano, Sokoto, and Yobe. This study compared the programmatic data of 2019 and 2020, as well as survey data collected during the pandemic. RI program variables included service delivery, leadership and governance, monitoring and evaluation/supportive supervision, community engagement, vaccine supply chain and logistics, and finance and financial management. Data were analyzed using SPSS (version 23, IBM), student t-test, and structural equation modelling. The results showed that RI programs were affected by the pandemic in terms of reduced meetings and low completion rates of action points in certain states. However, routine immunization support services increased owing to improved monitoring techniques and consistent vaccine deliveries, with fewer reports of stock-outs. The most significant impact of the pandemic was observed on activities coordinated at the healthcare facility level, whereas those at the state level were less impacted. The major challenges encountered during the pandemic included insufficient supplies and consumables, movement restrictions, shortage of human resources, and fear of infection.
Tue, 25 April 2023
ARTICLE | doi:10.20944/preprints202304.0883.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: adolescent; indigenous culture; condoms; sexual behavior
Online: 25 April 2023 (04:08:40 CEST)
The goal was to determine the personal, interpersonal, and sociocultural predictors of condom use among rural indigenous adolescents. Predictor variables were selected from Bandura's Social Cognitive Theory and Leininger's Transcultural Theory. The sample consisted of 419 Nahuas adolescents randomly selected from the total number of neighborhood blocks in a rural community in Puebla, Mexico. The instruments had acceptable psychometric characteristics (Cronbach alpha and validity scores). Multiple linear regression models were used. Results: 56.8% of participants were female, and 50.40 % were students. The mean age was M = 17.5 (SD = 0.97), and the majority (63%) identified as Catholic. Age at menarche/first ejaculation (β = -1.2, p = .038), attitude toward condom use (β = .13, p < .001), ethnic identity (β = .21, p < .001), and ability to negotiate condom use (β = .13, p < .003), predicted (R2 = 22.3) condom use. This study provides a basis for the integration of the cultural values of indigenous adolescents within interventions for sexual health promotion.
Wed, 19 April 2023
ARTICLE | doi:10.20944/preprints202304.0411.v2
Subject: Public Health And Healthcare, Primary Health Care Keywords: Probabilistic model; Patient safety; Infectious Mononucleosis
Online: 19 April 2023 (04:39:26 CEST)
Infectious mononucleosis (Mono) is mostly caused by the Epstein-Barr virus (EBV), and can spread through infected people sharing food and drinks with others. Once this virus gets into your system, it is there to stay. The virus can get activated when a person has low immunity and can cause major complications. Furthermore, if physicians miss the diagnosis of this disease, and prescribe penicillin-based antibiotics, it can cause severe rash and adverse reactions that compromise patient safety. This paper develops a simple Hidden Markov Model using which a Viterbi algorithm provides the maximum a posteriori probability estimate for the most likely hidden state path, given a sequence of symptoms arising as observations from a patient with hidden EBV positive or negative states. Apart from bringing awareness to help reduce missed diagnoses and subsequent adverse events, this work provides a tool for health care systems to better incorporate prompts during electronic medical record (EMR) interactions to help physicians catch potential missed diagnoses during a visit. This research demonstrates how statistical models can be used to assess likelihood of underlying conditions that require tests to be offered by physicians in order to make a definitive diagnosis. The model developed and applied herein for estimating likelihood of EBV infection from a series of observations has the potential to alter guidelines within healthcare systems to ensure that the safety of patients, particularly teens, is not compromised due to a lack of definitive diagnosis for Mono at point of care.
REVIEW | doi:10.20944/preprints202304.0542.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: Human papillomavirus; Epidemiology; Prevention Strategies; Vaccination; Screening; Cervical Cancer; Gender Gap
Online: 19 April 2023 (04:32:32 CEST)
Background and aim: Human Papillomavirus (HPV) is sexually transmitted, one of the three most common sexually transmitted infections (STIs) in both males and females, and the most common viral STI. A crucial public health strategy to protect people against HPV is through vaccination, which has shown its effectiveness in preventing HPV related diseases. Presently three types of vaccines are available (bivalent, quadrivalent, and nonavalent) and they all target at least the two most oncogenic virus genotypes (HPV 16, 18). In the past few years, the need to implement vaccination programmes that include all genders has been discussed in order to achieve herd immunity against HPV. To date, only a few countries have included young males in their vaccination programmes, so we aim through this review to provide an overview of the epidemiology of HPV and prevention strategies to prevent it, reporting the latest findings from the scientific literature.
Mon, 17 April 2023
ARTICLE | doi:10.20944/preprints202304.0411.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: Probabilistic model; Patient safety; Infectious Mononucleosis
Online: 17 April 2023 (05:44:20 CEST)
Infectious mononucleosis is mostly caused by the Epstein-Barr virus (EBV), and can spread through infected people sharing food and drinks with others. Once this virus gets into your system, it is there to stay. The virus can get activated when a person has low immunity and can cause major complications. Furthermore, if physicians miss the diagnosis of this disease, and prescribe penicillin-based antibiotics, it can cause severe rash and adverse reactions that compromise patient safety. This paper develops a simple Hidden Markov Model using which a Viterbi algorithm provides the maximum a posteriori probability estimate for the most likely hidden state path, given a sequence of symptoms arising as observations from a patient with hidden EBV positive or negative states. Apart from bringing awareness to help reduce missed diagnoses and subsequent adverse events, this work provides a tool for health care systems to better incorporate prompts during electronic medical record (EMR) interactions to help physicians catch potential missed diagnoses during a visit. This research demonstrates how statistical models can be used to assess likelihood of underlying conditions that require tests to be offered by physicians in order to make a definitive diagnosis. The model developed and applied herein for estimating likelihood of EBV infection from a series of observations has the potential to alter guidelines within healthcare systems to ensure that the safety of patients, particularly teens, is not compromised due to a lack of definitive diagnosis for Mono at point of care.
Mon, 10 April 2023
ARTICLE | doi:10.20944/preprints202304.0161.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: covid vaccination; excess mortality rate; control group
Online: 10 April 2023 (09:20:44 CEST)
Global research on the Covid-19 vaccine’s effectiveness is using methods that are misleading the scientific community and public opinion. There is a golden rule in medicine: to measure the effectiveness of an experimental medicine you need to have two groups. The group that will take medicine and the group that will not take medicine. You follow the health status of both groups for a few months and you will get objective results. This is the only proper methodology to verify the effectiveness of a new medicine. Articles cited from 1-5 did not use the gold rule. They develop different kinds of methodologies that all have no statistical significance. On the basis of their methodologies, they conclude that Covid-19 vaccines have a positive effect on public health. By comparing graphs of the intensity of vaccination and the rate of mortality we see that after the period of intense vaccination follows the period of higher excess mortality. Basic statistical data are confirming that Covid-19 vaccines increased the mortality rate.
Thu, 2 March 2023
ARTICLE | doi:10.20944/preprints202303.0032.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: Antibiotic stewardship; antibiotic prescribing; COVID-19; primary care; electronic health records; Antmicrobial Stewardship; AMS; General Practice
Online: 2 March 2023 (04:25:37 CET)
COVID-19 pandemic-related pressures on primary care may have driven inappropriate continuation of antibiotic prescriptions. Yet prescribing modality (repeat/non-repeat) has not previously been investigated in a pandemic context. Using the OpenSAFELY-TPP analytics platform, we analysed repeat/non-repeat prescribing frequency in monthly patient cohorts between Jan 2020–2022. In-depth analysis was conducted on Jan 2020 (“pre-pandemic”) and Jan 2021 (“pandemic”) cohorts. Per-patient prescribing and clinical conditions were determined by searching primary care record data using clinical code lists. Repeat prescribing was defined as >=3 prescriptions in a 6 month lookback period. Associations between demographics (e.g. age, sex, geography) and repeat/non-repeat prescribing were explored using unadjusted risk ratios. Antibiotic prescribing declined from May 2020; non-repeat prescribing declined more strongly than repeat prescribing (maximum declines -26% vs -11%, respectively). In the pandemic cohort, older patients were at higher risk of prescribing (especially repeat prescribing). The most common clinical conditions for repeat prescribing were COPD comorbidity and urinary tract infection. Comorbidities were more common among repeat vs non-repeat prescribed patients. In the pandemic cohort, vs pre-pandemic, repeat and non-repeat prescribing for comorbidities generally declined less compared with shorter-term conditions (infections, including COPD exacerbation/lower respiratory tract infection). Our findings inform ongoing development of stewardship interventions in England..
Tue, 13 December 2022
ARTICLE | doi:10.20944/preprints202212.0228.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: Hospital management; Tertiary care; healthcare; Administration; Patient experience
Online: 13 December 2022 (06:45:10 CET)
Patients satisfaction with fast and high-quality services is the most important in the healthcare settings and specially in outpatient departments and private clinics. High quality services on health sector are indicated by continuous quality improvement (CQI). CQI is a progressive incremental process focused on safety of all participants, outcomes, systematic process, regulated and improved working environment at the later than earlier stages. Among the various suggested strategies, we adopted the patents feedback to improve the quality of services our clinic. All of the patient visited hospital were sent a massage on mobile and requested to provide their feedback on our services. Roughly around 5% of all visitors responded and filled up questionnaire. Majority of them were satisfied with the services in various department. However, they provided us some suggestions to identify the further gaps and improve the services in improving patients experience at our clinic. We considered their feedback, identified problems, redesigned the policies and implemented. After implementation of new strategies, we preliminary again evaluated the patients’ feedback on our services. Patients feedback explores that optimized methods of services for the has considerably increased the patients’ satisfaction. Taken together, our this shows that patients’ feedback is very important factor to improve patients’ experience at outpatient clinics using continuous quality improvement tools. For that reason, this study would serve as reference for public health stack holders, administrators and researchers.
Thu, 1 December 2022
ARTICLE | doi:10.20944/preprints202212.0001.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: medical workforce shortage; rural and remote; recruitment and retention; sustainable rural medical workforce; medical school innitiatives.
Online: 1 December 2022 (01:05:35 CET)
.Abstract: Indonesia, one of the Asia Pacific LMICs, has suffered from a chronic medical workforce shortage. However, there are limited published studies describing the approaches implemented by the Indonesian government regarding the recruitment and retention of the medical workforce. This case study aimed to understand the current practices for recruitment and retention of the medical workforce in Indonesian rural and remote provinces. We conducted a case study of the Maluku Province of Indonesia with document analysis and key informant interviews with officials responsible for medical workforce recruitment and retention. We used the WHO’s guidelines as an analytical matrix to examine the recruitment and retention practices under four domains, i) educational, ii) regulatory, iii) financial, and iv) professional and personal development, and classified them into University/Medical School level and Government/Non-government level. Our findings suggest that Indonesia has implemented most of the WHO-recommended medical workforce recruitment and retention strategies. However, implementation is still problematic; hence, the aim of establishing an adequate, sustainable medical workforce has not been reached. Nationwide government intervention in educational aspects is important to magnify the impact of the regional medical school initiatives. Relevant programs must be re-evaluated and re-enforced concerning significance, comprehensiveness and effectiveness for sustainable rural and remote medical workforce.
Tue, 1 November 2022
COMMUNICATION | doi:10.20944/preprints202211.0016.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: ME/CFS; ME; understanding; diagnosis; management; disabling; stigma
Online: 1 November 2022 (04:27:10 CET)
The new NICE guideline for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), published in October 2021, makes significant changes in treatment recommendations. It acknowledges the complexity of this chronic medical condition, which always impacts quality of life and can be profoundly disabling, recognising the prejudice and stigma that people with ME/CFS often experience in the absence of any specific diagnostic test. The guideline outlines steps for accurate diagnosis, recognising post-exertional malaise as a core symptom; importantly, ME/CFS can now be diagnosed after just 3 months in a bid to improve long-term health outcomes. It recommends the need for individual, tailored management by a multi-disciplinary team, ensuring that the wellbeing of the individual is paramount. The guideline makes clear that any programme based on fixed incremental increases in physical activity or exercise, for example graded exercise therapy (GET), should not be offered as a treatment for ME/CFS and emphasises that cognitive behavioural therapy (CBT) should only be offered as a supportive intervention. Because of the rigorous methodology required by NICE Committee review and the inclusion of the testimony of people with lived experience as committee members, this guideline will influence the future diagnosis and management of ME/CFS in the UK and beyond.
Mon, 28 March 2022
ARTICLE | doi:10.20944/preprints202203.0352.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: Education program; school students; knowledge; attitude; practice; choking person
Online: 28 March 2022 (03:17:55 CEST)
Choking and foreign body aspiration are significant causes of mortality and morbidity in young youngsters. This study aimed to investigate the effects of education programs on school students ' knowledge, attitude, and practice towards a choking person. This quasi-experimental study with a pretest-posttest control group design included a total of 282 school students. The students were divided into an intervention group (n = 141) and a control group (n = 141). After both groups completed the pretest, the intervention group received an education program on first aid for a choking person. Then, both groups were subjected to a posttest at the end of the program. The descriptive and inferential statistics analyzed the data. There were no significant differences between the two groups within the study parameters at the pretest (P = > 0.05). However, at posttest, a significant difference was observed in the knowledge (p = 0.001), attitude (p = 0.024), and practice (p = 0.001) of the intervention group compared to the control group. The intervention group showed significant improvement in the students’ knowledge, attitudes, and practices regarding first aid for a choking person. We suggest a continuous training program to improve the competency of first aid for a choking person.
Fri, 26 November 2021
ARTICLE | doi:10.20944/preprints202111.0496.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: School feeding programme; Osun Elementary School Feeding and Health Programme (O-MEALS); enrolment and retention; rural pupils; primary schools
Online: 26 November 2021 (10:08:06 CET)
School Feeding Programmes are social safety net interventions providing educational and health benefits to vulnerable children in developing countries. This study assessed the impact of Osun Elementary School Feeding and Health Programme (O-MEALS) on the enrolment and retention of rural primary schools in Osun State. Multi stage sampling technique was used to select 188 respondents while data was collected through interview schedule. Percentages, Chi-square, PPMC and T-test were used for data analysis. Findings revealed that over half (51.6%) of the respondents were male, aged 9.38 ± 1.84 years and majority (83.0%) had a family size of 6-10 people. Food incentives (=1.25), health challenge (=0.69), and peer influence (=0.67) were major factors affecting school attendance. More than half (53.2%) of the respondents had unfavourable perception towards the school feeding programme. Results showed a significant difference between pupils’ enrolment (t = 5.332, p = 0.006) and retention rate (t = 58.386, p = 0.000) before and after the commencement of O-MEALS. Furthermore, pupils’ enrolment and retention (r = 0.993, p = 0.001) after the commencement of O-MEALS was significantly related. Food incentive was a major factor affecting school attendance, which fostered an improvement in the poor enrolment and retention previously experienced. Since a good number of the pupils possessed unfavourably perception towards the school feeding programme, it was recommended that effective monitoring be established to checkmate food vendors’ activities in delivering quality and satisfactory services. Likewise, the Government’s policies on school restructuring and levy, which had proved counterproductive, should be reviewed.
Mon, 18 October 2021
ARTICLE | doi:10.20944/preprints202110.0236.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: Blood Pressure; Rope Exercise; physical activity; Lifestyle Modification; Adolescents; BMI; Hypertension; Cardiovascular risk factors; Academic Performance
Online: 18 October 2021 (10:21:34 CEST)
There are evidences of shared biological mechanisms between obesity and hypertension during childhood in the adulthood, and loads of research literatures have proven that, it will cost the economies and health of nations profoundly if neglected. The Prevention and early diagnosis of cardiovascular risk factors such as overweight and hypertension is an essential strategy for control, effective treatment and prevention of its’ complications. The aim of the study is to assess the effect of school based Exercise and Life style Motivation Intervention (SEAL-MI) on adolescent's cardiovascular risk factors and academic performance. An experimental study was conducted among 1005 adolescents - 520 and 485 adolescents were randomly selected for control and study group, respectively. Demographic details and the data related to dietary habits, physical activity and sleep quality were collected by a structured interview questionnaire. The study group adolescents were given the SEAL-MI for six months which includes a school based rope exercise for 45 minutes per day for 5 days a week and a motivation intervention related to dietary habits, physical activity and sleep. Post-test 1 and 2 were done after 3 and 6 months of intervention. The prevalence of overweight among adolescents was 28.73% and prehypertension was 9.26%. Among overweight adolescents, the prevalence of prehypertension was found to be very high (32.25%). In post intervention, there was a significant reduction in weight, BP (p=0.000) and improvement in dietary habits, physical activity, sleep (p=0.000) and academic performance. A significant positive correlation was found between BMI and SBP (p=0.000) and BMI and academic performance (p=0.003). The linear regression analyses revealed that the gender (ß: 0.47, 95% CI: 0.39, 0.81), age (ß: 0.39, 95% CI: 0.17, 0.46), family income (ß: 0.2, 95% CI: 0.41, 0.5), residence (ß: 0.19, 95% CI: 0.01, 0.27) and type of family (ß: 0.25, 95% CI: 0.39, 0.02) had the strongest correlate with the BMI of the adolescents. Also, Mother’s education Mother’s education (ß: 0.35, 95% CI: 0.18, 0.59) had the strongest correlate with the SBP of the adolescents. In contrast, the DBP was negatively persuaded by age (ß: -0.36, 95% CI: 1.54, 0.29) and gender (ß: -0.26, 95% CI: 1.34, 0.12) of the adolescents. Regular practice of rope exercise and lifestyle modification such as diet, physical activity and sleep quality among adolescents prevent and control childhood CVD risk factors like overweight, hypertension. The SEAL-MI may lead to age appropriate development of adolescents and improves their academic performance and quality of life. Giving importance to the adolescents from urban habitat, from affluent nuclear family and catching them young will bring significant change in the disease burden.
Tue, 7 September 2021
ARTICLE | doi:10.20944/preprints202109.0129.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: antimicrobial resistance; antibiotic prescribing; acute non-complicated infections; primary care; data-based feedback; mixed logistic regression model; multi-faceted intervention
Online: 7 September 2021 (13:54:02 CEST)
The three-armed cluster-randomized trial ARena (Sustainable reduction of antibiotic-induced antimicrobial resistance) aimed to foster appropriate antibiotic use and reduce overprescribing in German ambulatory care to counter antibiotic resistance. Multi-faceted interventions targeted primary care physicians, teams and patients. This study examined effectiveness of the implementation program. ARena was conducted in 14 primary care networks with 196 practices. All arms received data-based feedback on antibiotics prescribing and quality circles. Arms II and III received different add-on components each. Primary outcome examined is the prescribing rate for systemic antibiotics for cases with non-complicated acute infections (upper respiratory tract, bronchitis, sinusitis, tonsillitis, otitis media). Secondary outcomes refer to prescribing of quinolones and guideline-recommended antibiotics. Based on pseudonymized quarterly claims data, mixed logistic regression models examined pre-post intervention antibiotic prescribing rate changes and compared to matched standard care. A significant rate reduction (arm I 11.7%; arm II 9.9%; arm III 12.7%) and significantly lower prescribing rates were observed for all arms (20.1%, 18.9% and 23.6%) compared to matched standard care (29.4%). Fluoroquinolone prescribing was reduced in all intervention arms and rates for recommended substances generally increased. No significant post-interventional difference between intervention arms was detected. Findings indicate implementation program impact compared to standard care. Trial registration: ISRCTN, ISRCTN58150046
Tue, 13 April 2021
DATA DESCRIPTOR | doi:10.20944/preprints202104.0351.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: lecture based instruction; actual community-based instruction; maternal and child care; social competency skills; community awareness
Online: 13 April 2021 (12:47:52 CEST)
Maternal-child care is one of the foundations of primary health care. Nurses’ competency skills they have been taught. Community awareness is an important part of preventive healthcare, and nurses must be aware of the factors that impact the health of the community. This study examines the effectiveness of lecture-based instructions in maternal and child care and its implications to students' social competency skills and community awareness in Nursing Colleges in Nueva Ecija, Philippines. The researcher uses survey questionnaire and employed the descriptive design where fifteen (15) nursing students and five (5) teachers were purposively selected. The findings revealed that the weighted mean for the effectiveness of lecture based instruction in maternal and child care is 3.91 with verbal description of “Effective”, the effects of lecture based instruction in maternal and childcare to students’ social competency skills and community awareness got the weighted mean of 3.87 and interpreted as “very satisfactory” and the effectiveness of actual community-based instruction is very effective with weighted mean of 4.25 and is higher compare to lecture based instruction. The results also revealed that students and teachers were challenged in lecture-based instruction in maternal and chi8ldcare during distance learning. Recommendations for the enhancement of lecture-based instruction in maternal and childcare in social competency skills and community awareness were also made.
Mon, 5 April 2021
ARTICLE | doi:10.20944/preprints202104.0102.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: bullying, character, education, teenager, family
Online: 5 April 2021 (11:39:46 CEST)
The research objective was to determine the problem of bullying in teenagers. The method used is a qualitative approach with literature study methods and a quantitative approach with the e-survey method. The results showed that bullying was rife in the school environment with teenagers aged 12-15. Verbal bullying occurs the most because it is the easiest to do. Bullying occurs with a group of people against one person because of peer influence. Family factors, school, the influence of friends, environmental conditions, and television shows influence bullying. Character Education can help overcome bullying in teenagers because it teaches the value of virtue in daily activities if given early and not during teenager. The conclusion found in this activity is that teenagers can become bullies because of family, school, peer influence, social conditions, and television broadcasts. Character Education is more effective if it is implemented since early childhood education and all relevant stakeholders must be actively involved in providing the Character Education.
Tue, 15 September 2020
REVIEW | doi:10.20944/preprints202009.0337.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: hand sanitizers; hand rubs; alcohol based; disinfection; hand hygiene; coronavirus; COVID-19
Online: 15 September 2020 (09:07:09 CEST)
The global use of alcohol based hand sanitizers (ABHS) as a means of controlling the transmission of infectious disease increased dramatically in 2020 as governments and public health agencies across the world advocated hand hygiene as a preventative measure during the COVID-19 pandemic. Although the performance of these products is most commonly defined as a function of their alcohol concentration, they are multifaceted products in which an interplay of several factors is important in determining efficacy. The hand sanitizer tetrahedron, is a novel concept that considers both ABHS formulation factors and product performance factors from a multi-dimensional perspective. The four faces of the tetrahedron represent input/formulation factors: 1) the type and amount of alcohol, 2) inactive ingredients, 3) the type of formulation/delivery system and 4) manufacturing practices. The four corners of the tetrahedron represent output/product performance factors: 1) efficacy, 2) sensory characteristics, 3) usage, usability and compliance and 4) product safety/adverse effects. All factors are of importance to ensuring the effectiveness and utility of these products.
ARTICLE | doi:10.20944/preprints202009.0323.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: COVID-19; lockdown; CNN; DLNN; GRU; mental anxiety; hybrid approach
Online: 15 September 2020 (02:56:33 CEST)
COVID-19 and new concept, lockdown, change social life of all classes of humans. Children partially feel the changes of daily life and this situation has been children’s free mind. Children are under a new type of restriction imposed on them by their parents. Normally they prefer play with their their friends than study and always waiting for holidays. They heard a new jargon i.e. lockdown where everything stands still. Very often they see peoples in the roads and few vehicles are moving in the roads. However, a peculiar thing happens now that they sit in front of computer to hear the virtual classes that are taken by the teachers. This also happens when there is no lockdown since COVID-19 still affects people. The environment is totally changed and they do not find any proper answers from the parents about the scenario.This study has been made an attempt to carry out the mental affairs of children in West Bengal, India. Several families are surveyed for collecting responses mostly from rural areas as well as urban areas for the time-period from April, 2020 to July, 2020. An effort has been given in this paper to predict the stress, depression and anxiety faced by children during the COVID-19. A Deep Learning Neural Network (DLNN) based method is applied to understand the stress level, depression level and anxiety level amongst the children. A hybrid DLNN has been presented in this research that combines both Convolutional Layer and Gated-Recurrent Unit (GRU) for obtaining the prediction of the mental health of children. The model obtains an accuracy of 89.57% for defeminizing mental anxiety of children.
Wed, 2 September 2020
REVIEW | doi:10.20944/preprints202009.0030.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: multi-morbidity; CGA; frailty; polypharmacy; deprescribing
Online: 2 September 2020 (06:04:17 CEST)
Multi-morbidity and polypharmacy are common in older people and pose a challenge for health and social care systems especially in context of global population ageing. They are complex and interrelated concepts in the care of older people that require early detection and patient centred decision making that are underpinned by the principles of multidisciplinary led comprehensive geriatric assessment (CGA). Personalised care plans need to remain responsive and adaptable to the needs of a patient, enabling an individual to maintain their independence.
Mon, 17 August 2020
Subject: Public Health And Healthcare, Primary Health Care Keywords: Nutritional Surveillance; Public Health; Community Health Nursing; Public Health Nursing; Children’s health; Community Participation
Online: 17 August 2020 (10:08:36 CEST)
Effectively responding to children’s nutritional status and eating behaviors in Mozambique requires a community-based care approach grounded in sound nursing research that is evidence-based. The Community Assessment, Intervention, and Empowerment Model (MAIEC) is a nursing theoretical model that bases clinical decision-making for community health nurses using communities as a unit of care. We used the MAIEC to identify a community-based nursing diagnosis to address children’s nutritional status and eating behaviors in Mozambique. Objectives: (1) To conduct a descriptive study of children’s nutritional status and eating behaviors in a school community in Mavalane, Mozambique, and (2) to identify a community-based nursing diagnosis using the MAIEC clinical decision-making matrix in the same school community. Method: A cross-sectional, quantitative study was conducted to assess the nutritional status of children using anthropometric data, including brachial perimeter and the tricipital skinfold, and standard deviation for the relation of weight-height, in a sample of 227 children. To assess community management of the problem and identify a community-based nursing diagnosis, we surveyed 176 parents/guardians and 49 education professionals, using a questionnaire based on the MAIEC clinical decision matrix as a reference. Results: Malnutrition was identified in more than half of the children (51.3%). We also identified a community-based nursing diagnosis of impaired community management related to the promotion of child health and healthy eating as evident by lack of community leadership, participation, and processing among more than 70% of the community members (parents/guardians and education professionals). Conclusion: A nursing diagnosis and diagnostic criteria for nutritional status and community management were identified. The need to intervene using a multidisciplinary public health approach is imperative, with the school community as the unit of care. In addition, reliable anthropometric data were used to complement the nursing diagnosis and guide future public health interventions.
Fri, 24 July 2020
Subject: Public Health And Healthcare, Primary Health Care Keywords: Nutritional Surveillance; Public Health; Community Health Nursing; Public Health Nursing; Children’s health; Community Participation
Online: 24 July 2020 (14:49:10 CEST)
Objectives: to identify the nutritional status of children in a school community and to identify the nursing diagnosis in the community management focus for the promotion of child health and healthy eating in that community. Method: a cross-sectional, quantitative study was conducted to assess the nutritional status of children using anthropometric data, including brachial perimeter and the tricipital skinfold, in a sample of 227 children, from which the brachial mass area and brachial fat area, and the respective Z Scores were calculated. To assess community management we surveyed 176 parents and 49 education professionals, using a questionnaire based on the MAIEC clinical decision matrix as a reference. Results: we identified severe malnutrition in most children (51.3%) and a community management committed to the promotion of child health and healthy eating in more than 70% of the community members (parents and education professionals). Conclusion: Children’s nutritional status and diagnosis in community management were identified. The need to intervene in a multidisciplinary approach has become objective, with the school community as the unit of care, in a systemic perspective, regarding to the application of the Nursing process.
Thu, 7 May 2020
ARTICLE | doi:10.20944/preprints202005.0125.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: accreditation; quality; safety; primary care
Online: 7 May 2020 (13:17:59 CEST)
Background: Accreditation is a qualitative assessment aimed at technical-professional quality, but above all, at organizational and measurable aspects through process and outcome checks. Method: There are few references in the literature relating to the accreditation and improvement of the quality and safety of care and treatment in the field of primary care. Clinical Governance must also be applied and certified in the field of primary care. Results: An accreditation system for general medicine is proposed based on a new dynamic model and implement that meets different requirements and assessed on the basis of indicators. Discussion: In the current Italian health system, accreditation of health structures is addressed only to public hospitals and private structures and to providers of services and services, however primary care. GPs / PLS do not have quality and safety guarantee systems or models or systems or public or private accreditation certifications with the SSR and SSN. Conclusion: Given the fundamental importance in the NHS of primary care of MG / PLS as the main and fundamental provider of services to the patient in all his socio-welfare and clinical needs, it is considered essential to think and implement an accreditation system extended to the territorial general practice as already present and in place for all affiliated and provider structures on behalf of the NHS.
Mon, 16 March 2020
REVIEW | doi:10.20944/preprints202003.0258.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: digital environments; over exposure; children; vitamin D; melatonin; myopia; sleep loss; depression; obesity internet addiction; serotonin; dopamine; oxidative stress
Online: 16 March 2020 (04:22:15 CET)
Environmental studies, metabolic research, and state of the art neurobiology point towards the reduced amount of natural day and sunlight exposure of the developing child’s organism as the consequence of increasingly long hours spent indoors online as the single unifying source of a whole set of health risks identified worldwide, as is made clear in this review of the current literature. Over exposure to digital environments, from abuse to addiction, now concerns even the youngest (ages 0 to 2), and triggers, as argued on the basis of clear examples herein, a chain of interdependent negative and potentially long-term metabolic changes. This leads to a deregulation of the serotonin and dopamine neurotransmitter pathways in the developing brain, currently associated with online activity abuse and/or internet addiction, and akin to that found in severe substance abuse syndromes. A general functional working model is proposed under the light of evidence brought to the forefront in this review.
Wed, 15 May 2019
ARTICLE | doi:10.20944/preprints201905.0188.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: smartphone dependency; aggression; ego-resilience; parenting behavior; peer attachment
Online: 15 May 2019 (10:45:15 CEST)
This study was conducted to examine the moderating and mediating effect of ego - resilience, parenting attitude, and peer attachment in the relation between smartphone dependency and aggression. Participants were 1,863 youths using a smartphone among the first middle school students responded in the 7th Korean Children and Youth Panel Survey (KCYPS) conducted by the National Youth Policy Institute in Korea. The data were analyzed by descriptive statistics, a correlation, and a hierarchical regression analysis. First, ego-resilience showed a partial mediating effect on the relationship between smartphone dependency, aggression and significant moderating effects were revealed. Second, parenting behavior showed a partial mediating effect on the relationship between smartphone dependency and aggression, with no moderating effects seen. Third, peer attachment had a partial mediating effect on the relationship between smartphone dependency and aggression, with no moderating effects seen. The research suggested the mental health and growth of students could be improved by applying various nursing and health care programs to improve ego-resilience, parenting behavior and peer attachment as they grow into adulthood.
Tue, 5 February 2019
ARTICLE | doi:10.20944/preprints201902.0052.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: health care, human resources, inequality, Gini coefficient.
Online: 5 February 2019 (11:33:20 CET)
Human resources are the major input of health systems therefore the equitable distribution of human resources in health care remain critical in making progress towards the goal of universal health coverage and thus to sustainable development. The purpose of this study is to evaluate the health care human resources distribution across regions of Poland between 2010 and 2017 and estimate the level of equity. This research by applying to Polish conditions will allow to fill in the gap in existing literature. Data was derived from the Knowledge Database Health and Health Care of Statistic Poland and Polish Statistical Yearbook. In purpose to examine the distribution of health resources against population size and geographic size in Poland, the Gini coefficient calculated based on the Lorenz Curve was engaged. This study has several major findings. The amount of most types of human resources – as apart from internist, obstetrics and gynecology, occupational medicine - when expressed as number of them per 10,000 population or 1 square km increased in 2017 compared to 2010. Moreover, for most types of health care human resources the level of access slightly changed during analysied period as Gini coefficients decreased. However, the geographical distribution of all types of human resources is less equitable then in case of population distribution. The most troublesome is relatively lower equity in case of oncologist, family medicine and occupational medicine and cardiologist in both population and geographical distribution. Thus this research provides some implications for policy and practice. As the main reason to establish National Health Fund (which meant the centralization of the system) in Poland was to to eliminate regional differences in access to health care, thus this research confirms that still some more corrective actions, in this field, should be undertaken.
Thu, 20 September 2018
ARTICLE | doi:10.20944/preprints201809.0423.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: palliative and end-of-life care; older adults; advance care planning (ACP); health care professionals.
Online: 20 September 2018 (16:59:45 CEST)
This paper reports the findings from a pilot study designed to explore the barriers, facilitators and similarities with the delivery and implementation of two distinct models of Advance Care Planning (ACP) documentation for older adults in their last year of life used by health care professionals in their clinical practice. PACe (Proactive Anticipatory Care Plan): a GP led model and PEACE (Proactive Elderly Persons’ Advisory CarE): a nurse led model with community geriatrician oversight were used by participants in their clinical practice. Telephone interviews were conducted with general practitioners (GPs) to explore their views of using the PACe tool. Hospital admission avoidance matrons took part in face to face interviews and care staff employed in private residential care homes took part in individual telephone interviews to explore their views of using the PEACE tool. GPs and admission avoidance matrons were employed by Clinical Commissioning Groups (CCGs) and all study participants were recruited from the South East of England where data collection took place in 2015. Nine telephone interviews and two face-to-face interviews (one joint and one individual) were conducted with twelve participants. The data was analysed thematically. Participants highlighted the similarity of both tools in providing focus to ACP discussions to inform individual end-of-life care preferences. The importance of relationships was a pivotal theme-established, trusting inter-professional relationships to enable multidisciplinary teamwork and a prior relationship with the older person (or their proxy in the case of cognitive impairment) to enable conversations of this nature. Using both tools enabled participants to think critically and reflect on their own practice was another theme identified. Notwithstanding participants’ views to improve the layout of both tools, using a paper-based approach to deliver streamlined ACP and end-of-life care was a theme to emerge as a barrier which focused on the problems with access to paper-based documentation, accuracy and care co-ordination in the context of multidisciplinary team working. The value of technology in overcoming this barrier and underpin ACP as a means to help simplify service provision, promote integrated professional practice and provide seamless care was put forward as the solution.