Explore the vast range of titles available.

Primary Health Care (PHC) is considered a privileged space for the inclusion of students in the Unified Health System (UHS), which is most desirable the pedagogical scenario for the health course graduate education profile. However, its new financing model induces a neoselectivity that may mischaracterize UHS principles in primary care. This study is a qualitative meta-synthesis to understand the challenges of teaching practice scenarios in PHC, identified in the research, in order to discuss them in light of the limits imposed by the neoselectivity, induced by the Previne Brasil Program (Prevent Brazil Program). A search was conducted on the Virtual Health Library (VHL) portal. The search strategy was designed using the following keywords: ‘practice scenarios in higher education’ (object), ‘challenges’ (qualifier) and ‘PHC’ (amplitude/limit). The selection of publications was carried out using the PRISMA protocol by two independent reviewers, and data analysis was performed in the thematic modality. The quality analysis of the articles was based on the CASP protocol and the internal validation of the excerpts was done by a third evaluator. From the 17 articles included in the review, it was possible to extract 5 analytical dimensions of the scenarios' challenges, which are related to: ‘care’, ‘teaching’, ‘management’, ‘health professionals' attitude’, ‘community attitude’. All dimensions presented several sub-themes, except for 'community attitude'. Given the existing challenges, the neoselectivity induced in PHC tends to intensify most of the problems. It is assumed that the impacts on PHC settings may, in the future, place it as a non-viable practice scenario.

The teaching-service-community integration is an important strategy for achieving changes in the training of human resources in health, in order to train professionals with a profile to work in the Brazilian Unified Health System (SUS, as per its Portuguese acronym). This study analyzed how it occurs and what are the contributions of the teaching-service-community integration in the view of professors from the first to the seventh period of Medicine, Nursing and Dentistry programs at a university in northeastern Brazil. This is an exploratory and descriptive study, with a quantitative approach. Data were collected using an interview form and analyzed with the help of SPSS software. The descriptive analysis of the data, the chi-square test and the calculation of the internal consistency of the evaluation scale were used. The study had the participation of 106 professors. Results show that practices were still predominantly performed in university clinics and hospitals, 76 (71.7%). Most professors, 59 (56.7%), consider the teaching-service-community interaction very important for the quality of training and recognize its importance in strengthening SUS, 89 (85.6%). Although there was resistance on the part of some professors to follow-up students in extramural services, most of them, 94 (89.5%), consider the role of professors as essential for changing health practices, especially professors in nursing and dentistry professors that carry out extramural practices (p < 0.01). Interdisciplinary practices were performed more frequently in the first two periods of the three courses and by the nursing course (p = 0.001). In turn, multiprofessional interaction predominates in the practical classes of the nursing course and practices held outside the university domain (p < 0.01). It is evident the need to institutionalize the teaching-service-community interaction, as well as to value initiatives that streamline and make teaching more flexible in multiprofessional and interdisciplinary activities, fundamental for the amendment of training in health.

Background: Since the publication of the White Paper for the Transformation of the Health System in South Africa in 1997, which included Policy on Integration of Mental Health Care into primary health care (PHC), there has been an emphasis on the promotion of health as well as the re-engineering of PHC to include the integration of mental health care into PHC. Although South Africa has made significant advances at the level of health-related policy development and legislation in trying to bring the country in line with international trends, there have been challenges with regard to implementation of policies, including that of integration of mental health care into PHC. Objectives: The aim of this study was to determine the challenges affecting the implementation of the Policy on Integration of Mental Health Care into PHC in KwaZulu-Natal (KZN) province of South Africa and to seek possible solutions. Method: A qualitative exploratory descriptive design was used to determine the challenges affecting the implementation of the Policy on Integration of Mental Health Care into PHC in KZN. The sample consisted of 42 participants of whom 4 were PHC managers, 6 were operational managers and 22 were professional nurses who were directly involved in implementing the policy at the operational level. Results: The challenges identified included lack of training in mental healthcare services for staff working in PHC, unavailability of mental health policies, inadequate resources, poor communication between management and staff, lack of skills among PHC nurses in identifying signs of mental illness and misdiagnosis of patients. Conclusion: Considering the challenges pertaining to PHC nurses’ abilities and skills to implement the Policy on Integration of Mental Health Care into PHC, PHC-trained nurses should engage in lifelong learning and be encouraged to develop their knowledge, skills and competence throughout their professional lives.

Objectives Many associations have recently recommended early integration of oncology and palliative care for more standard cancer care and better quality of life. We aimed to create a questionnaire to assess the opinion of medical oncologists and nurses about the clinical impact of the integrated palliative care and oncology (PCO) program. Methods A novel semi-structured questionnaire called Impact of Early Integration of Palliative Care Oncology (IEI PCO) questionnaire was developed and tested for validity and reliability then distributed to the oncologists and nurses working in Kuwait Cancer Control Center. Results After the pilot stage, testing the final questionnaire for validity and reliability was done with satisfactory results. Finally, the complete questionnaires were 170 out of 256 (response rate 66.41%). More awareness about the available palliative care services and the new available PCO services ( p -value < 0.001 for all). Most of the oncologists and nurses agreed with the currently available structure of PCO, appreciated the patients’ discharge plan and continuity of care of palliative medicine, admitted less work burden, a better attitude, and higher satisfaction ( p -value for all < 0.001) toward palliative care. Significant improvements in symptoms were appreciated by oncologists and nurses after the integration of palliative care ( p -value for all < 0.001. Oncologists and nurses valued repeated honest communication, discussion of the goals of care, dealing more effectively with ending active treatment, and higher acceptance of patients and families of PC policy of transfer, and significant progress in the care of end-of-life symptoms ( p -value for all < 0.001). Conclusions The IEI PCO questionnaire demonstrated the psychometric criteria for content, face, and construct validity and reliability. It provides a valuable tool to assess the impact of PCO integration. The opinion of medical oncologists and nurses was significantly positive toward the early integration of PCO in Kuwait in most aspects of care. This integration led to improved symptom control, end-of-life care, communication, and planned discharge and follow-up plans. Moreover, decreases the work burden, improves attitude, higher satisfaction of the oncology staff, and continuity of care. Key message What is already known? Many studies proved the role of integrated palliative and oncology care but no available tools to assess this impact in clinical practice. What does this study add? • Impact of Early Integration of Palliative Care and Oncology Questionnaire (IEI PCO) is a newly developed and validated tool that can be used for evaluation of the impact of the PCO integration program. • It compares symptom control, end-of-life care, professional communication, structure, and clinical practice of PCO before and after integration and how this can affect the work burden, attitude, and satisfaction of oncology staff. How this study might affect research, practice, or policy? • It increases the awareness of oncology staff about the available PCO models such as ambulatory SPC team. The joint clinic, weekends round by SPC?etc • It can provide a guide to the important aspects that should be considered during the preparation of any PCO integration program and give feedback about aspects that need improvement.

Policy Points Systems based on primary care have better population health, health equity, and health care quality, and lower health care expenditure. Primary care can be a boundary‐spanning force to integrate and personalize the many factors from which population health emerges. Equitably advancing population health requires understanding and supporting the complexly interacting mechanisms by which primary care influences health, equity, and health costs.

Background Social care integration refers to the incorporation of activities into health systems that assist patients with health-related social needs (HRSNs) that negatively impact the health outcomes of their patients, such as food insecurity or homelessness. Social care integration initiatives are becoming more common. The COVID-19 pandemic strained health systems while simultaneously increasing levels of unmet social needs. Objective To describe the effects of the COVID-19 pandemic on established social care delivery in a primary care setting. Design We used qualitative semi-structured interviews of stakeholders to assess barriers and facilitators to social care delivery in the primary care setting during the COVID-19 health emergency. Data was analyzed using a hybrid inductive/deductive thematic analysis approach with both the Consolidated Framework for Implementation Research (CFIR) and the Screen-Navigate-Connect-Address-Evaluate model of social care integration. Setting Two safety-net, hospital-based primary care clinics with established screening for food insecurity, homelessness, and legal needs. Participants Six physicians, six nurses, six members of the social work team (clinical social workers and medical case workers), six community health workers, and six patients (total N  = 30) completed interviews. Results Four major themes were identified. (1) A strained workforce experienced challenges confronting increased levels of HRSNs. (2) Vulnerable populations experienced a disproportionate negative impact in coping with effects of the COVID-19 pandemic on HRSNs. (3) COVID-19 protections compounded social isolation but did not extinguish the sense of community. (4) Fluctuations in the social service landscape led to variable experiences. Conclusions The COVID-19 pandemic disrupted established social care delivery in a primary care setting. Many of the lessons learned about challenges to social care delivery when health systems are strained are important considerations that can inform efforts to expand social care delivery.