In connection with World Health Day on April 7

Recognising that clinical depression is a major public health problem in the State, the Health Department is for the first time integrating it into primary care by starting special depression clinics in selected primary health centres in the State. The programme was announced by Health Minister K. K. Shylaja here on Wednesday.

These special clinics for treating depression are being launched in connection with World Health Day on April 7. The World Health Organisation has identified depression as the focal theme this year.

WHO had in November last kicked off an year-long campaign, ‘Depression – Let’s Talk.’ It ranks depression as the single largest contributor to global disability and suicide deaths.

In Kerala, 9% of the adult population is suffering from common mental disorders, with depression topping the list, a reflection of which can be seen in the State’s high suicide rate of 22.6/ lakh population (2015).

The morbidity due to depression is huge in Kerala, with an estimated 5.8 per cent of males and 9.5 per cent of women suffering from this condition, according to Kiran P.S., Nodal Officer, State Mental Health Programme.

Depression is under-reported and not effectively treated in all global health systems and in Kerala too, less than 10 per cent of the affected receive effective treatment. A major barrier to effective care is inaccurate assessment.

In order to tackle depression as part of primary care, in the first phase, staff nurses and health workers attached to 170 public health centres, which are being converted as family health centres under the Comprehensive Primary Health Care programme, are being trained in basic psycho-social counselling and screening for depression in the community. Primary care physicians have already been trained in diagnosing and treating depression as part of the district mental health programme.

“The focus of screening will be on those at high risk of depression in the community. The cases screened and identified by health workers will be scrutinised and graded by doctors. We have developed WHO-guided treatment and referral protocols. Medicines will be provided at the PHCs and health workers will follow up the cases in the community,” Dr. Kiran said.

The medical officers at the PHCs will watch each case for four weeks and if there is no improvement or in case the patient requires a more detailed assessment, they will be referred to the psychiatric units at the district-level.

The important message to the public is that depression can be effectively treated.

At the core of WHO campaign is the message that families talk about it openly and seek help from professionals.

Source: thehindu.com

PEKANBARU - Dinas Kesehatan (Dinkes) Provinsi Riau pada tahun 2017 ini menargetkan 30 persen dari 865 ribu lebih wanita usia subur di Provinsi Riau untuk melakukan deteksi dini kanker servik atau kanker mulut rahim melalui IVA (Inpeksi Visual dengan Asam Asetat) test.

Dari pemaparan Kepala Dinkes Riau, Mimi Yuliani Nazir, kegiatan test untuk wanita yang sudah berkeluarga dan sudah melakukan aktifitas seksual tersebut merupakan bagian dari program Gerakan Masyarakat Hidup Sehat (Germas) yang sebagian fokusnya ada di Dinkes Riau.

Untuk Kota Pekanbaru, sebanyak 158 perempuan usia 30-50 tahun atau yang sudah menikah mendaftarkan diri untuk melakukan pemeriksaan IVA test saat kedatangan Ibu Negara Iriana Joko Widodo di Pasar Limapuluh Pekanbaru pada akhir Maret 2017 lalu.

“Dari 158 yang melakukan pendaftaran, sebanyak 105 diantaranya telah dilakukan pemeriksaan IVA dan empat orang ditemukan IVA positif dan telah dirujuk ke Rumah Sakit,” ujar Mimi saat pertemuan dengan para awak media di Kantor Dinas Kesehatan Riau, Rabu (5/4/2017).

Dilanjutkannya, selain di Pasar Limapuluh, IVA test juga dilakukan di GOR Universitas Islam Riau, dari 52 wanita yang diperiksa, 2 diantaranya IVA positif. “Untuk mendeteksi penyakit ini dibutuhkan pemeriksaan selama dua tahun berturut-turut, bila negatif, bisa diperpanjang selama tiga tahun berturut-turut” tambah Mimi.

Dari tujuh kegiatan Germas dalam rangka kegiatan promotif dan prefentif, pada tahun ini ada tiga fokus sosialisasi yang dilakukan Dinkes Riau, yaitu melakukan aktifitas fisik, mengkonsumsi sayur dan buah serta memeriksakan kesehatan secara rutin.

“Germas bukan hanya di Dinkes saja, ada beberapa Satker (satuan kerja) yang terlibat didalamnya,” ujar Mimi.

Ia menjelaskan bahwa program Germas juga dijalankan oleh sejumlah dinas, seperti jalur sepeda dan pejalan kaki yang ditangani Dinas Perhubungan, sarana aktifitas fisik di pemukiman serta ruang terbuka hijau yang ditangani Dinas Pekerjaan Umum, gerakan memasyarakatkan makan ikan yang dipegang oleh Dinas Perikanan dan Kelautan serta masih banyak lagi.

Sementara itu, Kepala Unit Pelayanan Terpadu Laboratorium Kesehatan dan Lingkungan Rinkes Riau, Dedi Parlaungan, menyampaikan bahwa pihaknya siap mendukung pemeriksaan secara rutin bagi masyarakat yang hendak melakukan pendeteksian secara dini maupun segala macam bentuk pemeriksaan yang memerlukan laboratorium.

“Untuk pribadi ada pilihan lain dari masyarakat, mengapa diperiksa di lab yang mahal, sementara di lab ini bisa jauh lebih murah namun dengan kualitas yang sama,” kata Dedi. (*)

Sumber: tribunnews.com

About one-third of primary care physicians offer palliative care services, allaying some concern about a growing senior patient population and a shrinking palliative care workforce, according to research published in the Journal of the American Board of Family Medicine.

According to the research team, the number of older adult patients needing palliative and patient-centered end-of-life care will increased from 46 million to 69 million between 2015 and 2030. This influx of older patients, who due to medical advances will experience “a prolonged trajectory of dying,” will require extensive palliative care.

With more patients needing patient-centered end-of-life care, it will be increasingly important for primary care providers to assume part of these duties, the research team asserted. However, prior to this study it was unclear how much of the primary care workforce was already delivering palliative care services.

The research team conduced a cross-sectional analysis of responses from the 2013 American Board of Family Medicine Maintenance of Certification and Demographic Survey to determine the number of primary care physicians delivering some palliative care services.

Of the 10,894 family physicians surveyed, 33 percent reported that they provide at least some palliative care. Physicians seeing patients in hospice, nursing homes, or during home visits were more likely to deliver palliative care than physicians conducting in-office visits with patients.

Other characteristics that predicted palliative care delivery included practicing in western or rural areas and practicing in or applying for patient-centered medical home certification. Older, white, male physicians were also more likely to deliver palliative care than other demographics, the researchers reported.

The varying demographics for primary care physicians delivering palliative care are concerning, according to the researchers. Industry leaders should be concerned that older, white, male providers in rural areas are the most likely population to deliver palliative care, the researchers pointed out. With such a restricted clinician base offering these services, patients may see their palliative treatment options wane in the future.

However, the researchers did see some promise in the results. As noted above, providers practicing in or applying for patient-centered medical home certification were 1.73 times more likely to deliver palliative care than those who were not associated with a patient-centered medical home.

“It is reassuring that those with or pursuing PCMH certification are more likely to report palliative care provision given the current policy emphasis on supporting PCMHs,” the researchers said.

Going forward, researchers will need to determine how they can encourage more primary care physicians to deliver palliative care, especially in the wake of a growing senior patient population. Although it is promising that one-third of primary care physicians deliver palliative care, it will be key for more to adopt the practice to ensure patients have adequate access to these services.

In November 2016, the JABFM published other research findings suggesting the importance of primary care physicians in driving palliative care availability.

Currently, there are not enough palliative care specialists for the number of patients needing those services.

“Palliative care specialists cannot meet the palliative needs of all people with serious illness because of limitations of reimbursement for the delivery of non-hospice palliative services; limitations of hospice eligibility to the last months of life, despite the patient suffering that occurs throughout the trajectory of the illness; and a lack of adequate numbers of palliative specialists,” explained the researchers in the 2016 report.

Healthcare professionals are increasingly recognizing the importance of primary care providers in delivering some palliative care services. Specifically, primary care physicians are well-suited to offering some basic palliative services, such as pain and symptom management, depression and anxiety management, prognosis and treatment discussion, and advance care planning.

However, through qualitative telephone surveys, the research team found that many primary care providers felt ill-prepared to deliver palliative care services, especially aspects about advance care planning.

“Most saw these conversations as challenging at times, usually because of a patient’s or family’s resistance in acknowledging the realities of declining disease trajectories and sometimes because of the positive interpretations patients took from conversations with medical specialists,” the researchers explained.

Ultimately, primary care providers reported that with proper training and financial support, aspects of palliative care did have a place in the primary care office.

“Careful attention should be paid to the multidimensional, patient-focused, specialist palliative approach during this evolution,” the researchers concluded. “Adapting that approach and implementing it systematically in primary care practices to provide basic supportive care alongside appropriate disease management may better meet the triple aim.”

Source: patientengagementhit.com

Medical schools working to close the primary care gap often find themselves struggling against barriers of their own making.

The ongoing shortage of primary care physicians remains a concern across the medical industry, and med schools have historically harbored a cynical view of primary care, to the point where some elite medical schools don’t even bother with departments of family medicine.

That has meant students actively seeking a career in primary care commonly experience a less-than-encouraging academic atmosphere, according to a recent article in Medical Economics. “I definitely got messages along the way where I could tell people had the attitude of, ‘it’s fine if you want to do that, but it’s not anything impressive,’” said Diana Huang, a student at the Lewis Katz School of Medicine at Temple University, describing the lukewarm response she received from the medical school community regarding her chosen specialty.

The article points to a relative lack of mentors and role models for aspiring primary care physicians, whether due to burnout or existing biases among medical school administrators and faculty members. The article describes this phenomenon as advancing a “hidden curriculum” that marginalizes primary care.

As an internist, Stuart Markowitz, M.D., senior associate dean for student affairs and admissions at Florida Atlantic University’s Charles E. Schmidt College of Medicine, is acutely aware that many doctors steer students away from the business. His institution counters this tendency by ensuring primary care specialists have a louder voice among faculty and administrators.

“Students hear a lot about primary care from us, both in medical education and student affairs,” he says.

Primary care’s position toward the bottom of the salary scale has also been a deterrent for students facing ever-higher debt loads. The industry has begun to respond to this situation recently, however, with a trend toward rising starting salaries and higher compensation in general among primary care physicians.

Source: fiercehealthcare.com

SINGAPORE: The Ministry of Health (MOH) will launch a call for general practitioners (GPs) to join its Primary Care Networks (PCN) scheme on Apr 1.

Participating GPs will be able to tap on funding and administrative support to implement team-based care to better monitor and manage their patients’ healthcare needs, the ministry said in its press release on Wednesday (Mar 29).

Under the scheme, MOH will provide funding and administrative support to GPs to form virtual networks and deliver care as multi-disciplinary teams which include doctors, nurses and other supporting staff. This support includes funding for nurse counsellors and care coordinators, as well as support to establish chronic disease registries, it added.

The GPs who are part of the scheme will have to follow stipulated clinical requirements, such as establishing a chronic disease registry for more effective monitoring and early intervention of patients’ clinical and care outcomes, according to the press release.

“Patients will be able to access nurse counsellors for individualised advice to manage their conditions, including lifestyle and dietary modifications,” MOH said. “There will be closer monitoring of their chronic conditions for earlier intervention, and more convenient access to services such as diabetic foot and eye screening.”

The application call will close on May 31 this year, the ministry said. 

- CNA/kk

Source: channelnewsasia.com