The promises and challenges of health information technology in primary health care

Territorialization using georreferencing and stratification of the social vulnerability of families in Primary Care

This article describes a process of territorialization undertaken in Family Health Strategy micro-areas by a team of residents from the Interprofessional Public Health Residency Program at Cariri Regional University using georeferencing tools and the stratification of families according to degree of social vulnerability. A map of social vulnerability was created using SW Maps and Google Earth Pro based on sociodemographic and clinical data obtained from forms A and B of the e-SUS and inputted into an Excel worksheet. The families were stratified into five degrees of vulnerability based on the overall score obtained for a set of socioeconomic and clinical sentinel indicators: without risk, low risk, medium risk, high risk and very high risk. During the territorialization process, we identified streets and side streets and georeferenced points of risk, social facilities, registered and unregistered families, and vacant homes. Over half of the 615 georeferenced families (316 or 51.38%) were not registered in the e-SUS or had not completed their registration at the time of data collection. Most of the 299 registered families (60.53%) were classified as being at low risk and a considerable portion were medium risk.

Development and validation of an instrument for measuring competencies on public health informatics of primary health care worker (PHIC4PHC) in Indonesia

Because of the increasing adoption and use of technology in primary health care (PHC), public health informatics competencies (PHIC) are becoming essential for public health workers. Unfortunately, no studies have measured PHIC in resource-limited setting. This paper describes the process of developing and validating Public Health Informatics Competencies for Primary Health Care (PHIC4PHC), an instrument for measuring PHC workers' competencies in public health informatics. Method: This study developed a questionnaire that had three stages: the Delphi technique, a pretest, and field test. Eleven academicians from a university and 13 PHC workers joined 2 rounds of group discussion in the first stage. The second stage comprised two pilot studies with 75 PHC workers in Semarang Municipality. The third stage involved validating the questionnaire with 462 PHC workers in Kendal District. This study used Pearson's product-moment correlation for the validity check and Cronbach's alpha coefficient for determining the internal consistency. This study used the K-means algorithm for clustering the results of the PHIC4PHC questionnaire. Results and Conclusion: PHIC4PHC is the first comprehensive PHIC questionnaire administered in a resource-limited setting, consisting of 11 indicators and 42 measurement items concerning knowledge of health information systems, skills required for health data management, ethical aspects of data sharing and health information literacy. The final results of PHIC4PHC were clustered into three classes based on the K-means algorithm. Overall, 45.7% PHC workers achieved medium competency, whereas 25.6% and 27.7% achieved low and high competency, respectively. Men had higher competency than women. The higher the worker's level of education, the higher the PHIC level; the longer the worker's work experience, the lower the PHIC score; and the greater the worker's age, the lower the PHIC score. Measuring and monitoring PHIC is vital to support successful health IT adoption in PHC.

National Immunization Program Information System: implementation context assessment

BACKGROUND

The National Immunization Program Information System (SIPNI - Sistema de Informação do Programa Nacional de Imunização) in Brazil is a technological innovation management tool that enhances the performance of managers and health professionals in the evaluation and monitoring of immunization activities. In the country, the decentralization of the System is at an advanced stage, but it still faces challenges regarding its operation and use, impacting on its results. This study aims to evaluate the deployment of SIPNI in the state of Minas Gerais, in 2017.

METHOD

Cross-section study performed in Primary Healthcare vaccination rooms in 54 municipalities in the Brazilian state of Minas Gerais, in 2017. A multidimensional questionnaire was used with nursing professionals who work in vaccination rooms, containing questions about the structure (presence of an internet-connected computer, instruction manual, software version, IT professional for technical support, trained healthcare professional, use of communication channels to obtain system information) and the process (activities performed by the staff to operate the immunization information system) of their work. Those questions refer to the components of the information system: system management, immunized-patient records, and Movement of Immunobiological. Implementation Degree (ID) was defined by a score system with different weights for each criterion, according to the importance level observed in it, with a rating of: adequate, partially adequate, inadequate and critically inadequate. For data analysis, median was used as the summary measure, and Pearson's Chi-Squared Test was used for proportion comparison.

RESULTS

Municipal SIPNI is not adequately implemented and that results mainly from the actions performed in health service units, indicating problems in the use of technology by professionals working in vaccination rooms. The structure was better evaluated than the process, presenting IDs of 70.9 and 59.5%, respectively. Insufficient internet access, inadequate use of communication channels, and lack of professional qualification were some of the identified structural issues. "Movement of Immunobiological" was the best-ranked component (ID = 68.5%), followed by "immunized patient records" (ID = 59.3%) and "SIPNI management" (ID = 50.7%). Partial performance of SIPNI is independent of population size in the municipality and of FSH coverage.

CONCLUSIONS

SIPNI is still an underutilized technological innovation. There are challenges that must be overcome, such as implementation of the final web version, internet connectivity, and capabilities aimed at the use of information generated by technology. Nevertheless, perspectives regarding SIPNI are positive, with functionalities to optimize activities in vaccination rooms.

Physiotherapy managers' views of musculoskeletal physiotherapy service provision in Ireland: a qualitative study

Aim Integrated multidisciplinary primary healthcare is still in a relatively early stage of development in Ireland, with significant restructuring occurring in the past decade. Musculoskeletal physiotherapy services traditionally provided in acute hospital settings have been relocated into the primary care setting where the physiotherapist works as part of the multidisciplinary team. This study aimed to explore physiotherapy managers' experiences of managing musculoskeletal physiotherapy services in primary care to gain an insight into the opportunities and challenges in service delivery, changing roles and ongoing professional development needs of staff. Participants Qualitative design using semi-structured interviews with primary care physiotherapy managers in the Republic of Ireland was employed.

RESULTS

Five interviews took in a mix of rural and urban areas nationally. The relationship with the GP was an important one in musculoskeletal physiotherapy services in primary care. Physiotherapists were well skilled but opportunities for professional and career development were restricted. Methods of optimising resources in the face of staffing restrictions were identified. Whilst there were many examples of innovations in service delivery, various barriers negatively impacted on optimal service including resource constraints and national strategy.

CONCLUSIONS

A number of factors that impact on musculoskeletal service delivery in primary care from the perspective of physiotherapy managers were identified in this study. Future research should explore the views of other stakeholders to provide a more thorough understanding of the relevant issues affecting musculoskeletal physiotherapy service provision in primary care in Ireland.

The Knowledge, Awareness, and Practices of Portuguese General Practitioners Regarding Multimorbidity and its Management: Qualitative Perspectives from Open-Ended Questions

Multimorbidity's high prevalence and negative impact has made it a subject of worldwide interest. The main aim of this study was to access the Portuguese knowledge, awareness, and practices of general practitioners (GPs) regarding multimorbidity and its management, in order to aid in the development of interventions for improving outcomes in multimorbid patients in primary care. A web-based qualitative descriptive study was carried out in the first trimester of 2016 with primary care physicians working in two districts of the Centre region of Portugal. Open-ended questions were analysed via inductive thematic content analysis. GPs pointed out several difficulties and challenges while managing multimorbidity. Extrinsic factors were associated with the healthcare system logistics' management (consultation time, organization of care teams, clinical information) and society (media pressure, social/family support). Intrinsic factors related to the GP, patient, and physician-patient relationship were also stated. The most significant conclusion to emerge from this study is that although GPs perceived difficulties and challenges towards multimorbidity, they also have the tools to deal with them: the fundamental characteristics of family medicine. Also, the complex care required by multimorbid patients needs adequate consultation time, multidisciplinary teamwork, and more education/training.

National Immunization Program: Computerized System as a tool for new challenges

The scope and coverage of the Brazilian Immunization Program can be compared with those in developed countries because it provides a large number of vaccines and has a considerable coverage. The increasing complexity of the program brings challenges regarding its development, high coverage levels, access equality, and safety. The Immunization Information System, with nominal data, is an innovative tool that can more accurately monitor these indicators and allows the evaluation of the impact of new vaccination strategies. The main difficulties for such a system are in its implementation process, training of professionals, mastering its use, its constant maintenance needs and ensuring the information contained remain confidential. Therefore, encouraging the development of this tool should be part of public health policies and should also be involved in the three spheres of government as well as the public and private vaccination services.