Family Medicine and Primary Care

Universal health coverage – Time to dismantle vertical public health programs in India Raman Kumar Journal of Family Medicine and Primary Care 2019 8(4):1295-1296 Primary care has traditionally meant different concepts for developed and developing economies/countries. Immediately after independence, India pushed aside the recommendations of the Bhore committee, which was for implantation of comprehensive primary healthcare. Instead, we opted for the path of selective primary care modeled on vertical disease–based programs under the guidance of international development agencies. After several decades of implementing selective primary healthcare, India has now embarked upon ambitious journey of universal health coverage (UHC) with announcement of Ayushman Bharat – National Health Protection Mission. How much we resolve and how much we refer (90% vs 10% and 10% vs 90%) within primary care will determine the overall cost of the health system, be it out of pocket or publicly funded. Implementation of comprehensive primary healthcare and UHC along with existing disease focused vertical public health programs is a unique situation to India. Will the Indian economy be able to sustain the double burden of UHC and the vertical programs? Or is it indeed the time to dismantle the vertical programs and implement comprehensive primary care towards containing over all cost of the health system to the country. Continuing both may be a good bankruptcy plan.

NOMOPHOBIA: NO MObile PHone PhoBIA Sudip Bhattacharya, Md Abu Bashar, Abhay Srivastava, Amarjeet Singh Journal of Family Medicine and Primary Care 2019 8(4):1297-1300 The term NOMOPHOBIA or NO MObile PHone PhoBIA is used to describe a psychological condition when people have a fear of being detached from mobile phone connectivity. The term NOMOPHOBIA is constructed on definitions described in the DSM-IV, it has been labelled as a “phobia for a particular/specific things”. Various psychological factors are involved when a person overuses the mobile phone, e.g., low self-esteem, extrovert personality. The burden of this problem is now increasing globally. Other mental disorders like, social phobia or social anxiety, and panic disorder may also precipitate NOMOPHOBIC symptoms. It is very difficult to differentiate whether the patient become NOMOPHOBIC due to mobile phone addiction or existing anxiety disorders manifest as NOMOPHOBIC symptoms. The signs and symptoms are observed in NOMOPHOBIA cases include- anxiety, respiratory alterations, trembling, perspiration, agitation, disorientation and tachycardia. NOMOPHOBIA may also act as a proxy to other disorders. So, we have to be very judicious regarding its diagnosis. Some mental disorders can precipitate NOMOPHOBIA also and vice versa. The complexity of this condition is very challenging to the patients' family members as well as for the physicians as NOMOPHOBIA shares common clinical symptoms with other disorders. That's why NOMOPHOBIA should be diagnosed by exclusion. We have to stay in the real world more than virtual world. We have to re-establish the human-human interactions, face to face connections. So, we need to limit our use of mobile phones rather than banning it because we cannot escape the force of technological advancement.

Basthi Dawakhana of Hyderabad: The first Urban Local Body led community clinics in India Chandrakant Lahariya Journal of Family Medicine and Primary Care 2019 8(4):1301-1307 Basthi Dawakhana initiative was launched by the Greater Hyderabad Municipal Corporation (GHMC) in Telangana state of India, in April 2018. This article documents, reviews, and analyzes the key design aspects of Basthi Dawakhana, delve into why such clinics are important for strengthening primary health care in Indian cities and urban settings, and proposes a few strategies for implementation effectiveness. In the main text of the article, evolution of urban health services, national urban health mission in India, and Mohalla clinics of Delhi has been provided. The implementation challenges and potetnial solutions for scaling up Basthi Dawakhana have been discussed. The author argues that Basthi Dawakhana initiative is aligned with the 73rd and 74th amendments in the Constitution of India, which transferred the responsibilities for primary care and public health to the Urban Local Bodies (ULBs). The article concludes that Basthi Dawakhana are arguably the first ULB-led community clinics initiative and an opportunities for ULBs in India to lead efforts to strengthen primary healthcare. These Dawakahna along with Mohalla Clinics, can serve platform to reform urban primary healthcare services and advance universal health coverage (UHC) in the country.

Oral tuberculosis - Current concepts Supriya Sharma, Jyoti Bajpai, Pankaj K Pathak, Akshyaya Pradhan, Priyanka Singh, Surya Kant Journal of Family Medicine and Primary Care 2019 8(4):1308-1312 Tuberculosis (TB) is a chronic infectious disease that can affect various parts of the body including the oral cavity. It primarily affects the lungs. TB bacilli can spread hematogenously to different parts of the body and this also involves maxilla or mandible. Although oral lesions are infrequent, they are crucial for the early diagnosis and interception of primary TB. Intercepting the disease early will limit the morbidity and mortality of the patients. It becomes the responsibility of the dentist to include TB in the differential diagnosis of suspicious oral lesions to prevent delay in the treatment of the disease. It would not be an exaggeration if the dental identification of the TB lesions has the potential of serving as a significant aid in the first line of control for this hazardous and often fatal disease. This article will also emphasize the advancing role of oral pathologists in making the final diagnosis of this dreaded disease.

Medication concordance in modern medicine – A critical appraisal from an Indian perspective Shubham Atal, Balakrishnan Sadasivam, Shah Newaz Ahmed, Avik Ray Journal of Family Medicine and Primary Care 2019 8(4):1313-1318 Modern medicine encompasses a holistic approach toward patient care that seeks to integrate the social, psychological, and pathological aspects of a disease. In line with this, the traditional model of improving treatment outcomes through improved compliance or adherence has given way to the concept of “concordance” that respects the integrity of the patient, autonomy, and self-determination. A self-conscious patient actively and equally participating in her or his comprehensive healthcare can bring a paradigm shift in the perceptions and functioning of the healthcare sector. Medication concordance can be expected to play a key role in improving patient well-being, clinical outcomes, and healthcare delivery. However, it is fraught with numerous questions to be addressed ranging from lack of clarity or standard protocol, medicolegal intricacies, cultural–linguistic barriers, illiteracy, shortage of time, infrastructure, and manpower. There are major challenges in the effective implementation of this initiative which has definite potential to prove beneficial in Indian healthcare settings. The success of this novel approach can only be accomplished by coordinated, inclusive, and persistent efforts from all participants of healthcare with fostering of a milieu of trust, belief, and communication. A systematic literature search was conducted using key words from relevant articles and MeSh terms on Google Scholar and PubMed. Data were abstracted according to their relevance to subheadings of the review and synthesis of concepts was done through multiple reviews by atleast two reviewers for any subsection.

Knowledge, attitude, and practice of family planning services among healthcare workers in Kashmir – A cross-sectional study Rabbanie Tariq Wani, Imrose Rashid, Sheikh Sahila Nabi, Hibba Dar Journal of Family Medicine and Primary Care 2019 8(4):1319-1325 Background: Researches have shown highest awareness but low utilization of contraceptives making the situation a serious challenge. Most of women in reproductive age group know little or have incorrect information about family planning methods. Even when they know the name of some of the contraceptives, they do not know where to get them or how to use it. These women have negative attitude about family planning, whereas some have heard false and misleading information, the current study aimed in assessing the knowledge, attitude, and practice of family planning among female healthcare workers in Kashmir valley. Method: A self-administered questionnaire was served to the female multipurpose health workers of District Anantnag and Baramulla at a training conducted in Department of Community Medicine, Government Medical College, Srinagar, Kashmir. Result: All the participants had heard about family planning methods. The major sources of information were trainers (78.8%). About 90.4% of the study participants gave correct response regarding the types of family planning. About 80.1% of the respondents had a favorable attitude toward family planning. Around three-fourths of the study participants practiced one or other method of family planning. Conclusion: Our study lead to the conclusion that the level of knowledge and attitude toward family planning was relatively low and FP utilization was quite low among the healthcare workers. In order to imbibe positive attitude among general public, the health workers need to be trained so as to inculcate the positive attitude in them leading to increased awareness among general public with regard to family planning.

A study on the change in HbA1c levels before and after non-surgical periodontal therapy in type-2 diabetes mellitus in generalized periodontitis Akshay Munjal, Yashika Jain, Sowmya Kote, Vineesh Krishnan, Rafi Fahim, Samruddhi Swapnil Metha, Deepak Passi Journal of Family Medicine and Primary Care 2019 8(4):1326-1329 Aim: The aim of this study was to evaluate and investigate changes in HbA1c levels before and after non-surgical periodontal therapy in type-2 diabetes mellitus patients with generalized periodontitis. Materials and Methods: A statistically significant number of type-2 diabetes mellitus subjects diagnosed with chronic generalized periodontitis were included in the study. The selected subjects were randomly allocated to 2 groups. Group 1: Control group: Subjects who received only scaling and root planning. Group 2: Test group: Subjects received antibiotic coverage with non-surgical periodontal therapy (scaling and root planning). Clinical parameters included plaque index, gingival index, PRO MIG pocket depth, and clinical attachment level. In addition, the metabolic parameters were recorded at the same time intervals, which included fasting blood sugar, random blood sugar, and HbA1c levels. Statistical Analysis: ANOVA test was applied to the parameters. Results: HbA1c more significantly reduced by test group compared to the other group. Conclusion: there is definitely a positive effect of nonsurgical on HbA1c levels in type 2 diabetes mellitus. This point levels significantly reduced after conventional non-surgical periodontal therapy. Conclusion: There is definitely a positive effect of non-surgical periodontal therapy on HbA1c levels in type 2 diabetes patients with chronic periodontitis.

Family medicine residents' educational environment and satisfaction of training program in Riyadh Abdullah H Al Helal, Yousef Al Turki Journal of Family Medicine and Primary Care 2019 8(4):1330-1336 Background: Improving health outcome indicators worldwide needs well-trained family physicians, and the Kingdom of Saudi Arabia is of no exception from that need. Objectives: To address the level of satisfaction and assess the educational environment among residents of family medicine (FM) in Riyadh city. Methodology: A cross-sectional study; the Postgraduate Hospital Educational Environment Measure (PHEEM) was used to assess the educational environment for all FM residents in fully structured training centers that include all levels of residents in Riyadh during 2016. Results: About 187 surveys were distributed and 140 were collected, with a response rate of 74.87%. Cronbach's alpha scored at 0.917 for overall items. Out of 160 maximum score, the overall score of the PHEEM was 86.73 (standard deviation [SD]: 19.46). The perception of teaching score was 33.11 (SD: 8.80) out of 60, the perception of role autonomy score was 28.60 (SD: 7.35) out of 56, and the perception of social support was 25.02 (SD: 5.43) out of 44. Conclusion: The educational environment is an important determinant of medical trainees' achievements and success. The results are better than what had been found in the previous studies, but more attention and effort should be done, especially for the poorly rated points in this study. We recommend a continuous evaluation and reconstruction of the Saudi Board of FM program, and such results could be a tool that might help in fostering better and stronger educational program.

Comparison of psychiatric screening Instruments: GHQ-28, BSI and MMPI Jamileh Jahangirian, Hossein Akbari, Ehsan Dadgostar Journal of Family Medicine and Primary Care 2019 8(4):1337-1341 Background: Clinical interview comprises a method for of psychiatric disorders diagnosis. Given the cost, time, and expertise required for clinical assessment; alternative tools to accurately substitute clinical interviews are having high value. We conduct this study to compare the screening accuracy of GHQ-28, BSI, and MMPI. Materials and Methods: Considering a diagnostic value, this study was conducted on 983 students and 3 psychiatric screening tools; GHQ-28, BSI, and MMPI were completed by students. Among the whole participants, 237 students were interviewed by the clinical psychiatrists on the basis of DSM-IV-IR Criteria. Based on ANOVO and Chi-square, results compare was made. Kappa correlation -coefficient was calculated in a pairwise manner; eventually the diagnostic accuracy of each tool was determined by the means of ROC analysis. Results: The diversity of psychiatric disorders by GHQ-28, was about 39.1, on the basis of BST was 44.8% and 44% for MMPI. The sensitivity and specificity of GHQ-28 was 85.9% and 87.8% considering 21.5 as the cut-off point; respectively. Considering 41/5 as the cut-off point for the BSI test, sensitivity and specificity were 81.2% and 90.8%; respectively, and 88.2% and 91.4% for the MMPI test with the cut-off point of 63.5 compared to clinical interview, the MMPI test was associated with the greatest accurate staging, ranging about 90.3%. Conclusions: The results of this study according to clinical assessment reveal that GHQ-28, BSI, and MMPI psychiatric tools have high sensitivity and specificity and MMPI possessed the greatest efficiency compared to other evaluated tools.

An investigation into the sensitivity of shear wave ultrasound elastography to measure the anterior bladder wall pressure in patients with neurogenic bladder Alireza Ghorbani Bavani, Mohammad Ghasem Hanafi, Mohsen Sarkarian Journal of Family Medicine and Primary Care 2019 8(4):1342-1346 Introduction and Objective: Urodynamic testing (urodynamics) is widely used for evaluating bladder function as a result of high detrusor compliance. This aggressive and uncomfortable test is especially difficult for children. This study aimed to determine the sensitivity of shear wave ultrasound elastography (SWE) as a new method for evaluating the biomechanical characteristics of bladder to measure the anterior bladder wall pressure in children with neurogenic bladder (NB). Materials and Methods: The present prospective clinical study was carried out on 30 children with allegedly NB and 20 healthy children as control group. These children referred to Ahwaz Golestan Hospital in 2018. After clinical evaluations, urodynamics was performed for children with NB and detrusor compliance was measured in cm/H2O. The ultrasonography of the SWE was performed on the anterior wall of the bladder (Estimated bladder capacity (EBC) 50%) for the two groups. The relationship between shear wave speed (SWS) and detrusor compliance was estimated using Pearson's correlation coefficient. Independent t-test was used to compare SWS between two groups. Results: In patients with NB, there was a significant relationship between the mean SWS of the anterior bladder wall and detrusor compliance (R = 0.89, P = 0.0001). The comparison between normal and NB groups showed that the mean SWS of the anterior bladder wall in the patients was significantly higher than the healthy group (1.88 ± 0.88 m/s vs. 0.94 ± 0.15; P = 0.0001). There was also no significant relationship between SWS, gender, age, weight, and body mass index of patients (P > 0.05). Conclusion: The results showed that SWE can be used as a useful alternative for urorodynamic testing in the evaluation of NB (bladder dysfunction) in children.