Aim and objectives: Using standard health administrative measures in primary care in conjunction with measures for attachment to a primary care provider, Primary Care Data Reports were produced for regionally based Ontario Health Teams (OHTs). Attachment categories include attached, uncertainly attached receiving primary care, and uncertainly attached without primary care services. This study looks at the key differences that occurred between the first (March 2020) and second version (March of 2022) of the reports.

Content and Approach: This cohort study used linked health administrative data sets in conjunction with measures of attachment to a primary care provider. Patient data is stratified according to key demographics, patient characteristics, health care utilization and primary care indicators. 6 priority populations of interest were produced by region based on policy decision maker input. These priority populations included those who attended the Emergency Department, were hospitalized, received home care, had a mental health diagnosis, and who were in palliative care or had a frailty diagnosis.

Results There was a 2.5% drop in the attachment rate to a primary care provider from 2020 to 2022. Full result to be include in the presentation.

Goals: Province wide changes in primary care attachment to a primary care provider worsened over the period 2020-2022. Full results to be included in presentation. Policy and decision makers need to prioritize attachment to a primary care provider.

This presentation will inform and educate on who is most likely to have a primary care provider in Ontario Canada.
2.This presentation will inform and educate on changes in attachment patterns to a primary care provider over the period of the COVID 19 pandemic.
3.Attachment to a primary care provider is a foundational outcome metric in primary care service provision.

Value based care is growing fast in the United States. Learn what it is in this informative session that will highlight definitions and why value based care is making a difference for family doctors. In this interactive session, brainstorm and share what and how value based care could be implemented in your country and consider the possibilities in outcomes.

1. Learn the basics of Value Based Care
2. Explore different models of care and payment across nations
3. Consider how value based care could make a difference for your practice

Workplace violence (WPV) in health care setting has become a matter of global concern. Violence, particularly in the emergency department (ED) is a well-known phenomenon across the globe. In Nepal, however, there is not much data regarding WPV in health care settings.

This study was conducted to explore the extent and various aspects of WPV in the ED of two tertiary care hospitals within Kathmandu, the capital city of Nepal.

This was a multi-center, cross-sectional descriptive study that was conducted among ED staffs working in emergency rooms of Bir and Patan Hospitals. Data were collected during a 2-week period in October, 2021 by using means of a self-report modelled questionnaire where by the researcher himself met the ED staffs, collected data where the respondents were asked to recall the forms of WPV in the recent three months period.

There were a total of 100 respondents (valid response rate 93%). Verbal abuse/ threat was experienced by 75 ED staffs and 3 of them reported to have experienced physical violence also. Nurses (94%, n=34) and paramedics (89%, n=8) were the most common victims of WPV. Female staffs were most at risk (84%, n=46). Visitors of the patient were identified as most common perpetrators of WPV (80%) and non-reporting to hospital authority by victims of WPV was found to be very high (75%, n=56).

Hospital administration, government bodies and other stakeholders of health care services must seriously work together on ways to create safer working environment for health care providers working in emergency departments.

Aim:
During the COVID-19 pandemic, digital health has become an important strategy to deliver health services, promote effective self-management, and improve healthy lifestyles to patients with chronic diseases, especially in primary care settings. This study aims to identify patterns of digital health utilisation in primary care settings among patients with chronic conditions, and to explore various strategies to strengthening digital health literacy in primary care settings.

Content:
A concurrent mixed methods study was conducted in three community health centres of Bali Province, involving a quantitative survey of 150 patients and in-depth interviews with 30 informants (15 patients and 15 health staff). Quantitative data were analysed using descriptive statistic, and qualitative data were analysed using a thematic approach. Around 26% of respondents never used digital health platforms and disagreed that access to e-health is essential for their health status. Primary care providers used social media platforms to share health education events, online booking, and online consult. Health staff in the study suggest the importance of digital health literacy among patients to manage hoaxes and incorrect information, particularly those obtained through social media platforms. Patients were comfortable with social media platforms, and these must be capitalised for improving self-management and patient outcomes. However, informants in the study seem to have sporadic understanding regarding the benefits of digital health in promoting self-management, indicating a lack of digital health literacy.

Goals:
Digital health platforms provide an opportunity for service adaptations in primary care settings, and these must be contextualised to patients’ need and local capacity. This study confirms that digital health can complement the existing clinical management and prevention strategies. More importantly, the study suggests an urgent call to develop digital health literacy strategies in primary care settings and to provide comprehensive digital health literacy skills for health providers and patients.

1. Digital health platforms provide an opportunity for service adaptations in primary care settings
2. Digital health can complement the existing clinical management and prevention strategies
3. There is an urgent call to develop digital health literacy strategies in primary care settings and to provide comprehensive digital health literacy skills for health providers and patients

Background. East Nusa Tenggara Province where Timor Island becomes the mainland is in high prevalence of stunting among children under-five. One of the risk factors is the mothers and perhaps their condition before marriage. This study aims to describe healthy status of female teen agers as future mothers about their capability to bear healthy baby.
Method. This is a cross sectional study in a remote Timor Island among female high school students. They were measured for weight and height, followed by dental and blood haemoglobin examinations. The haemoglobin was tested using Sahli’s method for estimation.
Results. Thirty-three students participated in this study, aged 16-18 years. The height measurements found 81% stunting. Weight measurements were 51% underweight, and 12% had body mass index less than percentile 5 (very low). Anaemia was found among 72% of the students. East Nusa Tenggara Province was high prevalence of stunting among children under-five for quite a long time. As a long-term public health problem, stunting might continuously happen from children under-five until teen age, and perhaps less detected. Therefore, the female teenagers as the future mothers had still the risks to deliver and raised children in a chronic situation that allows stunting to happen.
Conclusion. Chronic situation that affect nutrition status among female teen agers in remote village of Timor Island may impact to the continuity of stunting over generation. Such early detection of risk factors among female teen agers is important to be applied.

1. Stunting reflects a chronic situation that should be interfered
2. Such chronic malnutrition if not treated will continue until the child grows as an adult.
3. The situation will be a risk for the next generation.

Over the past 10 years, the competences of Slovak general practitioners have increased significantly. Their activity was limited to curative treatment, basic prevention with basal blood tests, vaccination. Most chronic conditions were managed by the specialist to whom the patient was referred. Currently, a Slovak general practitioner manages arterial hypertension, dyslipidaemia, prediabetes, obesity, and performs preoperative examinations. The general practitioner is competent to perform and evaluate ECG, ABI, FOB, INR, CRP, 24-hour blood pressure monitoring, solve acute hypertensive cases. A few GPs do abdominal ultrasonography. The GP performs cardiovascular risk stratification according to the latest guidelines and sets up adequate treatment. He applies and evaluates the Montreal Cognitive Test in indicated patients, who are then referred to specialists. During the covid-19 pandemic telemedicine procedures were added. From the patient's point of view, such comprehensive health care is welcome, because he can solve many of his problems in one place. All the mentioned activities, including preventive examinations, are covered by public health insurance beyond the capitation. This results in a higher medical and economic motivation of the general practitioner. On the other hand, it brings a much higher efficiency in the use of public funds, since specialized care is much more expensive and difficult to access. Last but not least, a timely and efficient GP service for the patient significantly reduces the number of preventable deaths.

Increasing the GP competences:
1. brings a significant benefit for the patient in the availability of services
2. gives greater opportunities for professional and economic growth to each practice
3. reduces preventable deaths and public financial costs

INTRODUCTION: Air-pollution is the greatest global environmental public health threat of the century. Trinidad and Tobago an oil and gas economy with one of the highest number of vehicles per capita in the Caribbean is also exposed to increasing Sand and Dust Storms (SDS). Identification and quantifying of air-pollutants are a pre-requisite for evaluating increasing health risks. This study seeks to measure particulates (PM2.5 and PM10) and volatile organic compounds (VOCs) in ambient air in Trinidad. Exceedance was determined using the World Health Organization (WHO) 2021 guidelines for particulates, and levels >1ppm for VOCs.
METHODOLOGY: A cross-sectional study was conducted during the period June 17 to July 9, 2022. Thirteen geographical sites representative of different land usage patterns, locations and exposures to prevailing winds were chosen for sampling. A portable HoldPeak HD-5800D device was used to test particulates while toxic gases were detected using a GASMET DX4040 portable multi-gas FTIR monitor. Data collected in duplicate on separate sampling days, for a one-hour period, was tabulated and analyzed using Excel. Linear regression utilizing Pearson’s r coefficient found a strong correlation between PM2.5 and PM10, r = 0.895, p<0.001. PM2.5 was therefore used as the reference standard for particulates.
RESULTS: PM2.5 were in exceedance 76.9% of the time. The highest levels were found on the east coast exposed to Saharan dust, with second highest levels in the industrial west. Local elevations in PM2.5 were associated with diesel trucks, while VOCs exceedance were associated with the use of organic chemicals, testing along roadways and a leaking oil pipeline.
CONCLUSION: Trinidad is exposed to levels of PM2.5 and VOCs that often exceed WHO threshold guidelines. As an industrialized economy, exposed to the increasing influence of SDS, longitudinal studies are needed as a pre-requisite for monitoring associations with negative health impacts and policy initiatives.

Family doctors all over the world are aware of the tensions in our workforce. Issues of where we sit in our country’s health system, whether we have to do postgraduate training to practise as a family doctor, the status of our discipline, or the financial and professional rewards we receive for our work, can influence whether people choose to be family doctors – and whether they remain in this role for their working lifetime. On top of this, family doctors can be drawn out of a country by perceived gains of working elsewhere – and some actively recruit doctors from other countries.

There are many good reasons to visit or spend some time in another country, and WONCA encourages some models of how to do this, a longterm or permanent loss of doctors can further increase health inequalities, and weaken the healthcare of some countries. This forum therefore focuses on
1) Some examples of the current flux of the FM/GP workforce - from Australia, Asia, Africa, Europe and IberoAmerica
2) Debating what models of international workforce movement can be deemed ethical and restorative, and which are potentially actively damaging.

Format would be to present workforce figures from all other countries – and then focus discussion on what should WONCA members be doing to address the tensions between welcoming and needing good doctors from any country to enter general practice versus the potential increasing impacts on workforce inequalities.

The aim is to raise awareness, add to existing knowledge, and potentially to help delegates be more able to choose positive ways to gain international experience without allowing this to be to the disadvantage of other colleagues and settings.

1.Delegates will be more knoweldgeable about the global influences on medical migration and will be better able to analyse risks in ther own country
2. Delegates will be more able to choose positive ways to gain international experience without allowing this to be to the disadvantage of other colleagues and settings.
3. This will also help WONCA members to shape policy at national level when we feed back the learning from the session

BACKGROUND
The devolution of the Philippines’ healthcare system caused fragmentation and burden to health facilities and providers. The referral system remained unreliable. Consequently, patients received suboptimal services, particularly those in far-flung areas. There were perceived competency gaps in patient care among health providers in the grassroots.

OBJECTIVE
An educational series, called EHQUIP, was developed and implemented to provide standardized management of patients across different levels of care to deliver the best quality health outcomes through capability building on learning and development.

METHODOLOGY
In the midst of the pandemic, a tertiary hospital conducted an educational needs assessment of healthcare workers from primary hospitals in a nearby province, a perennial source of referrals. Linkages were established, and a series of multidisciplinary topics were curated, focusing on the enhancement of primary care management.

Participants were a mix of physicians, nurses and midwives. A wealth of practical tools and strategies for streamlining processes were shared, ranging from best clinical practices to administrative processes using innovative and interactive platforms.

OUTCOME
These regular engagements transformed the services of the participating primary hospitals within the service delivery network. Upskilling led to enhanced primary care management. Referral systems became more streamlined, leading to better patient outcomes. Others established innovations in their respective clinical settings producing breakthroughs.

CONCLUSION
EHQUIP series in its third year continually bridges the service delivery gap, resulting in improved accessibility, quality, and efficiency of healthcare services.

The following are the key takeaways of the presentation
1. Capability building through learning and development improves accessibility, quality and efficiency leading to optimal health service delivery.
2. Upskilling enhances primary care management and helps establish innovative practices in different healthcare settings.
3. Standardized and streamlined processes produce a stronger referral system leading to better patient outcomes.

The healthcare journey to chronic dialysis can be a medical and psychological challenge. Patients may disengage from primary healthcare as dialysis approaches, but continuity of primary healthcare is vital for holistic, preventative care. The project aimed to understand the perspectives and experiences of consumers and key stakeholders about kidney care to prevent patients from falling through service gaps. The project conducted a qualitative interview study of 76 stakeholders and a survey of 58 consumers to gain insight into the challenges and barriers to primary care engagement. 79% of all patients had a regular GP. The findings showed multi-factorial challenges in maintaining primary care relationships, driven by inconsistent and inefficient communication and collaboration pathways. 22% of patients reported a decrease in the frequency of GP consultations, while 44% of patients were interested in their GP being more involved in the management of their kidney care.
The findings were translated into targeted initiatives, co-designed with key stakeholders, to develop collaborative partnerships for integrated person-centred care. An audit of renal discharge summaries found 30% of patient discharges did not have a summary completed and 89% of GPs stated the summaries lacked clear GP actions and continuity of care plans.
The findings were then translated into targeted initiatives to develop collaborative partnerships, including improved communication and GP involvement, patient education and support, and integrated care plans. An evaluation of the project confirmed the impact and sustainability of these changes.

We learnt a dedicated project officer is required to implement projects. Clinicians do not have the time/capacity to implement large projects. Consumers also expressed appreciation for the opportunity to provide honest advice and feedback to an impartial project officer.
Innovation and determination is required to implement successful and sustainable quality improvement strategies when delivering health care within large systems and across the primary/tertiary care interfaces.

1. Communication across the hospital/primary care interface is important for patient safety as it supports both clinicians and patients in understanding the plan of care
2. The value of deep listening to a range of consumers/stakeholders in determining key issues and the most effective options and pathways to improve models of care
3. A dedicated project officer is required to implement projects as clinicians do not have the time/capacity

Introduction: As one of the most vaccinated countries in America, Puerto Rico’s success in containing the pandemic has come after many months of strict public policy implementation. Government officials declared a state of emergency on the island on March 15th, 2020. These measures included closing all schools across the island, forcing educational administrators to improvise online school efforts to complete the academic year.

This significant increase in lock-down-related anxiety and depressive symptoms is an unfortunate observation across several countries in the world. A 50% increase in suicide attempts has been reported among adolescent girls in the US alone compared to statistics from 2019.

Our purpose is to compare the prevalence of depression in Puerto Rican pediatric patients, from a pediatric practice located in Mayaguez, Puerto Rico, between 9-21 years old prior to the pandemic lockdown (2018-2019) and compare results to those during the lockdown(2020-2021). In addition, we will compare Body Mass Indexes with PHQ-9 scores to determine if there is an association with higher BMI’s and a higher prevalence in depression.

Methods:
Patients were systematically selected filtering for age. The Patient Health Questionnaire-9 (PHQ-9) was used for children between the ages of 9-21 within the period of January 2018 and December 2021.

Results:
196 patients were reviewed via electronic medical record during 2018-2019 until 2021. There is an increased tendency in PHQ-9 scores was found in the 2020 group after lockdown although these results were not statistically significant.

This tendency between the groups was not associated to BMI as both groups had similar BMI’s. We did find a statistically significant association between higher PHQ-9 levels with increased BMI with a P value 0.005 and 96% confidence interval 0.06 to 0.33. Psychology referral was increased in 2020 with 40% referral compared to 28.3% in 2018-2019.

1. Pediatric mental health
2. Obesity and depression
3. Isolation related to depressive tendencies

Dispensing rates for antipsychotic and opioid medicines in Australia have dropped over five years, according to Atlas time series reports from the Australian Commission on Safety and Quality in Health Care (the Commission).

Nationally, there was an 11% reduction in the rate of antipsychotic medicines dispensed in people aged 65 years and over between 2016–17 and 2020–21, and an 18% fall in opioid medicines dispensing (all ages).

The drop in dispensing of these high-risk medicines is good news, but there is continuing geographic variation across Australia.

Data from the Atlas time series reports will be presented to show how mapping healthcare use can help GPs to identify potentially unwarranted variation and inappropriate care.

The reports build on data in the Australian Atlas of Healthcare Variation, which maps the use of health care according to where people live.

The interactive reports cover trends at national, state and territory, Primary Health Network (PHN) and local area levels.

The presentation will demonstrate how GPs and PHNs can use the interactive graphs to see how dispensing rates in their local area compare to other areas.

The Commission is working with PHNs that have consistently high rates of dispensing of antipsychotic and opioid medicines to understand reasons for the higher rates and to discuss strategies to reduce dispensing rates.

At the end of my presentation, attendees will know:
1.That mapping variation in health care according to where people live can identify potentially unwarranted variation and inappropriate care.
2. That dispensing rates of opioid and antipsychotic medicines have fallen, but there is continuing geographic variation in rates across Australia.
3. How to use the interactive graphs to explore dispensing rates in their own areas to help identify and address potentially unwarranted variation in opioid and antipsychotic medicines dispensing.