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Primary and Community Care: Opportunities and Challenges

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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Community Care".

Deadline for manuscript submissions: closed (31 March 2025) | Viewed by 30199

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Dr. Josep Vidal-Alaball

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Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Catalan Health Institute, Sant Fruitós de Bages, Spain
Interests: primary health care; public health; social media; medical education; telemedicine; eHealth
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Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on primary and community care in healthcare. The journal Healthcare is scientific and peer reviewed and publishes articles and communications in the areas of healthcare systems, industry, technology, policy, and regulation. For more detailed information on the journal, you can visit our website: https://www.mdpi.com/journal/healthcare.

Primary care is the first point of contact between patients and healthcare providers, and it plays a critical role in the prevention, diagnosis, and management of common medical conditions. Primary care providers, such as family doctors, nurse practitioners, and physician assistants, are responsible for providing comprehensive care that includes health promotion, disease prevention, and the management of acute and chronic illnesses. They also coordinate care with other healthcare professionals and refer patients to hospital specialists as needed. Community care, on the other hand, refers to a range of healthcare services that are provided outside of the hospital setting and are designed to support patients in their homes and communities. This includes home health services, hospice care, and mental health services. Community care is typically provided by a team of healthcare professionals who work together to deliver coordinated care to patients. Overall, primary care and community care are essential components of a comprehensive healthcare system. By providing accessible, patient-centered care that is focused on prevention and early intervention, these services can help to improve health outcomes and reduce healthcare costs in the long term. eHealth is increasingly taking on a significant role, and will continue to do so, in the delivery of primary care services. It has the potential to greatly improve patient access to care, promote patient engagement, support care coordination among providers, and facilitate preventive care. We welcome submissions on a variety of topics, including, but not limited to: examining the effectiveness of different models of primary care delivery; the impact of primary care on patient outcomes and healthcare costs; the impact of social determinants of health on access to community care; analyzing the role of community care in reducing hospital readmissions; examining the impact of integrated primary and community care on patient outcomes and healthcare costs; examining the impact of eHealth on primary care delivery; Analyzing the factors influencing patient adoption and use of eHealth in primary care; and the role of eHealth in promoting patient-centered care and improving health outcomes in integrated care.

Dr. Josep Vidal-Alaball
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

primary health care
community care
primary care models
general practice
general medicine
Family Medicine
Community-based care
Palliative care
home health services
patient-centered care
eHealth
telemedicine

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Published Papers (10 papers)

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Research

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23 pages, 307 KiB

Open AccessArticle

Informal Palliative Care at Home: A Focus Group Study Among Professionals Working in Palliative Care in Portugal

by Vanessa Marrazes, Laura Gonçalves, Ana Querido and Carlos Laranjeira

Healthcare 2025, 13(9), 978; https://doi.org/10.3390/healthcare13090978 - 23 Apr 2025

Abstract

Background/Objectives: Informal caregivers (ICs) are the backbone of home-based palliative care (PC) because they play a vital role in offering more seamless and timely support, preventing suffering and fostering comfort and dignity. Specialized home-based PC teams must recognize ICs’ unmet needs in fulfilling daily responsibilities and enhance their preparedness for caring. In this vein, this study aimed to carry out the following: (a) explore how PC professionals perceive the preparedness of ICs to provide PC at home and (b) determine what barriers and enablers they consider essential for the delivery of high-quality PC at home. Methods: Using purposeful sampling, thirty-four professionals from four disciplines who worked in specialized PC teams were recruited for a descriptive qualitative research study. Four focus group discussions were conducted from September 2024 to January 2025. This was followed by a thematic analysis according to Braun and Clarke’s framework. The findings are reported following the COREQ checklist. Results: Most of the participants were female nurses (n = 22) with a mean age of 41.8 ± 8.62 years. Three overarching themes were identified: (1) IC needs and motivations for providing care; (2) perceived barriers to good-quality palliative home care; and (3) perceived enablers of good-quality palliative home care. The IC’s preparedness depends on personal characteristics, health status, the scope of tasks, and the ramifications stemming from the complexity of the illness trajectory. Conclusions: Professionals deemed it essential for PC staff to be experienced, accessible, person-centered, and proactive. Furthermore, effective communication and a well-defined network for requesting certain community resources or services were deemed crucial for delivering high-quality PC at home. Full article

(This article belongs to the Special Issue Primary and Community Care: Opportunities and Challenges)

14 pages, 791 KiB

Open AccessArticle

Integrating Complementary and Alternative Medicine into General Practice Training: A Regional Survey in South Tyrol

by Christian J. Wiedermann, Giuliano Piccoliori and Adolf Engl

Healthcare 2025, 13(7), 797; https://doi.org/10.3390/healthcare13070797 - 2 Apr 2025

Viewed by 195

Abstract

Background/Objectives: Complementary and alternative medicine (CAM) is increasingly being recognized as an important component of primary care; however, its integration into medical education and practice remains inconsistent. This study explores the attitudes, practices, and educational needs of young career general practitioners in South Tyrol, a linguistically and culturally diverse region. Methods: A questionnaire was distributed to all 131 general practitioners currently in training or who completed their specialization within the last 10 years, and 37 responses were analyzed. Results: The findings revealed moderate support for CAM modalities such as phytotherapy, manual therapies, and acupuncture. Participants demonstrated limited confidence in their knowledge of CAM. Although 72% acknowledged the importance of CAM training, only a minority demonstrated adequate knowledge of reimbursements and relevant legislation. Women and urban practitioners showed tendencies toward higher confidence and engagement with CAM compared to men and rural practitioners, as indicated by effect size results. Conclusions: This study highlights the need for focused, evidence-based CAM training programs to bridge knowledge gaps and enhance integration into primary care. Although constrained by factors such as a limited participant pool, the results of the small-scale study offer perspectives regarding CAM training and its significance in meeting the changing requirements of both health care providers and their clients. Full article

(This article belongs to the Special Issue Primary and Community Care: Opportunities and Challenges)

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11 pages, 260 KiB

Open AccessArticle

The Associated Factors of Work Engagement, Work Overload, Work Satisfaction, and Emotional Exhaustion and Their Effect on Healthcare Workers: A Cross-Sectional Study

by Marina Moreno-Martínez and Iván Sánchez-Martínez

Healthcare 2025, 13(2), 162; https://doi.org/10.3390/healthcare13020162 - 16 Jan 2025

Cited by 2 | Viewed by 1362

Abstract

Background: In today’s fast-paced work environment, work engagement is crucial for both organizational success and individual well-being. Objective: Our aim is this study was to analyze the associated factors of work engagement, work overload, work satisfaction, and emotional exhaustion and describe their effect on nurses and physicians in the Central Catalonia Health Region during 2023. Methods: A multicenter cross-sectional study was conducted using an online questionnaire at the Territorial Management of Central Catalonia (Spain). The questionnaire was accessible from 28 November 2022 to 12 March 2023. The analysis was performed using the SPSS software. CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines were followed for communicating research results. Results: A total of 321 professionals answered the questionnaire, 60.7% of whom were nursing professionals and 39.3% of whom were medical professionals. Work overload, work satisfaction, and emotional exhaustion were associated with work engagement. Being a physician, permanent contracts, irregular work shifts, overtime, and salary were related to work overload and emotional exhaustion. Being a woman, salary, academic level, and irregular work shifts were related to work satisfaction. There was a gender inequality in work engagement among nursing professionals to the detriment of men. In terms of class inequality, there was a difference between occupational groups with respect to work overload and emotional exhaustion among women. Conclusions: Organizational practices need to be improved to promote greater engagement and work satisfaction, as well as to reduce emotional overload and exhaustion. This may include regulating unpaid overtime and promoting more stable working hours. Full article

(This article belongs to the Special Issue Primary and Community Care: Opportunities and Challenges)

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19 pages, 262 KiB

Open AccessArticle

Factors Affecting Glycemic Control in Patients with Type 2 Diabetes in Kalasin Province, Thailand: An Analytical Cross-Sectional Study

by Patcharin Phuwilert, Santisith Khiewkhern, Teerasak Phajan, Kasama Wongprachum, Jindawan Wibuloutai, Chitkamon Srichomphoo, Le Ke Nghiep and Kukiat Tudpor

Healthcare 2024, 12(19), 1916; https://doi.org/10.3390/healthcare12191916 - 25 Sep 2024

Viewed by 1947

Abstract

Background: Optimal glycemic management is critical since it can predict all associated essential causes of death, even after accounting for other risk factors. Objectives: This study investigated the factors associated with glycemic control in patients with type 2 diabetes mellitus (T2DM), particularly self-care behaviors. Methods: An analytical cross-sectional study examined 385 patients with T2DM in 1 general and 17 community hospitals in Kalasin Province. The samples were collected using mixed-method sampling. Data were collected using a validated questionnaire with six parts and laboratory examination records between September 2021 and December 2022. Descriptive statistics (e.g., percentages and means ± SD) were used to analyze the data. The relationship between relevant factors and lack of glycemic control was analyzed by multivariate logistic regression using SPSS version 25. Results: Results showed that most patients were female (78.18%), and the mean age was 59.84 ± 9.05 years. Additionally, a significant proportion of the patients (79.74%) had poor glycemic control. Several factors are significantly associated with poor glycemic control in patients with T2DM. These factors included subjects under the age of 60 years (OR = 2.95, 95% CI: 1.57 to 5.54; p-value < 0.001), a diabetes duration of over 10 years (OR = 3.95, 95% CI: 1.90 to 8.22; p-value < 0.001), poor knowledge about diabetes (OR = 3.92, 95% CI: 1.59 to 9.67; p-value < 0.003), and inadequate self-care behaviors (OR = 6.12, 95% CI: 3.20 to 11.68; p-value < 0.001). Conclusions: In conclusion, proper interventions for controlling glycemic level behaviors are necessary to improve proper self-care behaviors in patients who have a low knowledge level of T2DM, have had diabetes for over ten years, and are aged < 60 years. This approach can reduce the likelihood of experiencing disabilities and economic hardship. Full article

(This article belongs to the Special Issue Primary and Community Care: Opportunities and Challenges)

13 pages, 622 KiB

Open AccessArticle

Patient Safety Incidents in Primary Care: Comparing APEAS–2007 (Spanish Patient Safety Adverse Events Study in Primary Care) with Data from a Health Area in Catalonia (Spain) in 2019

by Montserrat Gens-Barberà, Maria-Pilar Astier-Peña, Núria Hernández-Vidal, Immaculada Hospital-Guardiola, Ferran Bejarano-Romero, Eva Mª Oya-Girona, Yolanda Mengíbar-Garcia, Nuria Mansergas-Collado, Angel Vila-Rovira, Sara Martínez-Torres, Cristina Rey-Reñones, Francisco Martín-Luján and QiSP-Tar Research Group

Healthcare 2024, 12(11), 1086; https://doi.org/10.3390/healthcare12111086 - 25 May 2024

Viewed by 1529

Abstract

The initial APEAS study, conducted in June 2007, examined adverse events (AEs) in Spanish Primary Healthcare (PHC). Since then, significant changes have occurred in healthcare systems. To evaluate these changes, a study was conducted in the Camp de Tarragona PHC region (CTPHC) in June 2019. This cross-sectional study aimed to identify AEs in 20 PHC centres in Camp de Tarragona. Data collection used an online questionnaire adapted from APEAS–2007, and a comparative statistical analysis between APEAS–2007 and CTPHC–2019 was performed. The results revealed an increase in nursing notifications and a decrease in notifications from family doctors. Furthermore, fewer AEs were reported overall, particularly in medication-related incidents and healthcare-associated infections, with an increase noted in no-harm incidents. However, AEs related to worsened clinical outcomes, communication issues, care management, and administrative errors increased. Concerning severity, there was a decrease in severe AEs, coupled with an increase in moderate AEs. Despite family doctors perceiving a reduction in medication-related incidents, the overall preventability of AEs remained unchanged. In conclusion, the reporting patterns, nature, and causal factors of AEs in Spanish PHC have evolved over time. While there has been a decrease in medication-related incidents and severe AEs, challenges persist in communication, care management, and clinical outcomes. Although professionals reported reduced severity, the perception of preventability remains an area that requires attention. Full article

(This article belongs to the Special Issue Primary and Community Care: Opportunities and Challenges)

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17 pages, 647 KiB

Open AccessArticle

Relationships between the Structural Characteristics of General Medical Practices and the Socioeconomic Status of Patients with Diabetes-Related Performance Indicators in Primary Care

by Undraa Jargalsaikhan, Feras Kasabji, Ferenc Vincze, Anita Pálinkás, László Kőrösi and János Sándor

Healthcare 2024, 12(7), 704; https://doi.org/10.3390/healthcare12070704 - 22 Mar 2024

Cited by 1 | Viewed by 1439

Abstract

The implementation of monitoring for general medical practice (GMP) can contribute to improving the quality of diabetes mellitus (DM) care. Our study aimed to describe the associations of DM care performance indicators with the structural characteristics of GMPs and the socioeconomic status (SES) of patients. Using data from 2018 covering the whole country, GMP-specific indicators standardized by patient age, sex, and eligibility for exemption certificates were computed for adults. Linear regression models were applied to evaluate the relationships between GMP-specific parameters (list size, residence type, geographical location, general practitioner (GP) vacancy and their age) and patient SES (education, employment, proportion of Roma adults, housing density) and DM care indicators. Patients received 58.64% of the required medical interventions. A lower level of education (hemoglobin A1c test: β = −0.108; ophthalmic examination: β = −0.100; serum creatinine test: β = −0.103; and serum lipid status test: β = −0.108) and large GMP size (hemoglobin A1c test: β = −0.068; ophthalmological examination β = −0.031; serum creatinine measurement β = −0.053; influenza immunization β = −0.040; and serum lipid status test β = −0.068) were associated with poor indicators. A GP age older than 65 years was associated with lower indicators (hemoglobin A1c test: β = −0.082; serum creatinine measurement: β = −0.086; serum lipid status test: β = −0.082; and influenza immunization: β = −0.032). Overall, the GMP-level DM care indicators were significantly influenced by GMP characteristics and patient SES. Therefore, proper diabetes care monitoring for the personal achievements of GPs should involve the application of adjusted performance indicators. Full article

(This article belongs to the Special Issue Primary and Community Care: Opportunities and Challenges)

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12 pages, 1481 KiB

Open AccessArticle

Screening for Patients with Visual Acuity Loss in Primary Health Care: A Cross Sectional Study in a Deprived Hungarian Population

by Rahul Naresh Wasnik, Veronika Győri-Dani, Ferenc Vincze, Magor Papp, Anita Pálinkás and János Sándor

Healthcare 2023, 11(13), 1941; https://doi.org/10.3390/healthcare11131941 - 5 Jul 2023

Cited by 1 | Viewed by 1977

Abstract

Screening for visual acuity loss (VAL) is not applied systematically because of uncertain recommendations based on observations from affordable countries. Our study aimed to evaluate the effectiveness of primary health care-based screening. A cross-sectional investigation was carried out among adults who did not wear glasses and did not visit an ophthalmologist in a year (N = 2070). The risk factor role of sociodemographic factors and the cardiometabolic status for hidden VAL was determined by multivariable linear regression models. The prevalence of unknown VAL of at least 0.5 was 3.7% and 9.1% in adults and in the above-65 population. Female sex (b = 1.27, 95% CI: 0.35; 2.18), age (b = 0.15, 0.12; 0.19), and Roma ethnicity (b = 2.60, 95% CI: 1.22; 3.97) were significant risk factors. Higher than primary school (b_{secondaryschoolwithoutgraduation} = −2.06, 95% CI: −3.64; −0.47; and b_{secondaryschoolwithgraduation} = −2.08, 95% CI: −3.65; −0.51), employment (b = −1.33, 95% CI: −2.25; 0.40), and properly treated diabetes mellitus (b = −2.84, 95% CI: −5.08; −0.60) were protective factors. Above 65 years, female sex (b = 3.85, 95% CI: 0.50; 7.20), age (b = 0.39, 95% CI: 0.10; 0.67), Roma ethnicity (b = 24.79, 95% CI: 13.83; 35.76), and untreated diabetes (b = 7.30, 95% CI: 1.29; 13.31) were associated with VAL. Considering the huge differences between the health care and the population’s social status of the recommendation-establishing countries and Hungary which represent non-high-income countries, the uncertain recommendation of VAL screening should not discourage general practitioners from organizing population-based screening for VAL in non-affordable populations. Full article

(This article belongs to the Special Issue Primary and Community Care: Opportunities and Challenges)

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13 pages, 591 KiB

Open AccessArticle

Prevalence of Respiratory Infections during the 2018–2020 Period in the Paediatric Population of Primary Care Centres in Central Catalonia

by María José Macías Reyes, Josep Vidal-Alaball, Eduardo Alejandro Suwezda, Queralt Miró Catalina, Maria Homs and Anna Ruiz-Comellas

Healthcare 2023, 11(9), 1252; https://doi.org/10.3390/healthcare11091252 - 27 Apr 2023

Cited by 2 | Viewed by 1668

Abstract

Following the COVID-19 pandemic, policies such as social distancing, hand washing, and the use of masks were implemented, which could play an important role in the reduction of infectious diseases. An observational, descriptive, cross-sectional study was conducted to observe the prevalence of respiratory infections in children under 15 years of age during the 2018–2020 period in Primary Care centres in Central Catalonia. In 2020, there was a 44.3% decrease in total consultations for respiratory infections compared to 2019. All respiratory infections exhibited a significant decrease except flu-like syndrome; children between the ages of 6 and 12 had the highest prevalence of flu-like syndrome (87.6%), and the SARS-CoV-2-19 infection was most frequent (4%) among those between the ages of 12 and 15. Compared to urban centres, rural centres presented a higher prevalence of all infections except flu-like syndrome and SARS-CoV-2. In conclusion, the COVID-19 pandemic caused a significant decrease in the number of consultations for respiratory infections in the paediatric population, except for flu-like syndrome, which increased in cases in January, February, and March 2020. No differences were found between sexes, although differences were found in the distribution of the different age groups. Full article

(This article belongs to the Special Issue Primary and Community Care: Opportunities and Challenges)

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19 pages, 1007 KiB

Open AccessReview

Neuropsychology of Generalized Anxiety Disorder in Clinical Setting: A Systematic Evaluation

by Evgenia Gkintoni and Paula Suárez Ortiz

Healthcare 2023, 11(17), 2446; https://doi.org/10.3390/healthcare11172446 - 31 Aug 2023

Cited by 21 | Viewed by 17604

Abstract

This research paper provides a systematic review of the neuropsychology of generalized anxiety disorder (GAD), examining relevant articles’ methodologies and subject matter and highlighting key findings. It suggests potential cognitive deficits in GAD patients, such as subtle attention, executive function, and working memory deficiencies. It also discusses neural correlates of GAD, particularly the hyperactivity in the amygdala and insula, and the additional impact of comorbidity with other psychiatric disorders. The paper uses the PRISMA methodology and draws data from the PsycINFO, Scopus, PubMed, and Elsevier databases. Although the reviewed research has contributed to understanding GAD’s cognitive and neural mechanisms, further research is required. Additionally, the paper mentions the clinical neuropsychology of GAD, including strategies and treatments, such as cognitive behavioral therapy (CBT), mindfulness, and medication. Lastly, the review identifies the limitations of the existing research and recommends future directions to enhance the understanding of GAD’s underlying cognitive and neural mechanisms. The neural underpinnings of GAD encompass heightened activity within the amygdala and insula, which are brain regions implicated in processing adverse emotional reactions. Co-occurring psychiatric disorders, such as major depressive disorder (MDD), can also impact neuropsychological functioning. Additional investigation is warranted to better understand the intricate interplay between GAD, cognitive performance, and underlying neural processes. Full article

(This article belongs to the Special Issue Primary and Community Care: Opportunities and Challenges)

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14 pages, 277 KiB

Open AccessViewpoint

Advancing District Nursing Care Through a Learning Healthcare System: A Viewpoint on Key Requirements

by Jessica Veldhuizen, Marieke Schuurmans, Misja Mikkers and Nienke Bleijenberg

Healthcare 2024, 12(24), 2576; https://doi.org/10.3390/healthcare12242576 - 21 Dec 2024

Viewed by 923

Abstract

The increasing complexity of healthcare needs driven by an ageing population places pressure on district nursing care. Many vulnerable older adults prefer to remain at home, requiring care coordinated with general practitioners and other professionals. This demand for integrated care is further challenged by a shortage of nursing professionals and the lack of standardised approaches to measure care quality. This article identifies the key requirements for implementing a learning healthcare system in district nursing care, using patient outcome data to foster continuous improvement and create a more adaptive, evidence-based, and patient-centred approach. This paper synthesises findings from multiple studies conducted as part of a PhD thesis, utilising a multi-method approach. These methods include examining patient outcomes in district nursing care and evaluating necessary cultural, organisational, and financial changes. Four key requirements were identified: (1) standardising patient outcome measures; (2) fostering a data-driven culture and strengthening professional autonomy; (3) enhancing organisational support and integrated care; and (4) adopting financing models that incentivise continuous learning and quality improvement. Implementing a learning healthcare system with patient outcome data in district nursing care requires a transformative shift. Standardising outcome measures, investing in information systems, and promoting continuous learning are crucial. Aligning financial incentives with patient outcomes, strengthening professional autonomy, and enhancing organisational support can make district nursing more responsive and capable of meeting complex needs. The described requirements are essential for advancing district nursing care through a more adaptive, evidence-based, and patient-centred approach. Full article

(This article belongs to the Special Issue Primary and Community Care: Opportunities and Challenges)

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