Introduction Outpatient services are crucial for strengthening primary healthcare and reducing out-of-pocket spending, which has been one of the major causes of impoverishment. So it is also critical to comprehend the people’s preferences in accessing primary healthcare facilities, as government primary healthcare facilities in India are underutilized. The current paper explores the factors that construct the individual’s decision to seek outpatient care in primary healthcare facilities in India’s largest state Rajasthan. Methods It was a cross-sectional survey conducted in 72 primary sample units of 24 primary health centers in 11 districts of Rajasthan, India, from November 2019 to January 2020. The study selected 368 households through purposive sampling. Out of 368 households, 460 people reported any illness and 326 reported outpatient visit to any health facility in the last 30 days from the date of the survey. Analysis The focus was on analyzing the data in the context of public and private health facilities to understand the factors influencing people’s choice to access outpatient services. The principal component analysis is used to understand the relationship between facility preparedness and OPD uptake. Also, multivariate logistic regression is applied to assess the significant predictors in using primary health facility services. Result Except for the 29% of patients who received no care, the proportion of patients attended public health facilities was 35%, and the rest were utilizing private health facilities. Those who sought care at PHCs were mostly over 45 years age, non-literate, and from the lowest wealth quintile. Logistic regression suggests that people belong to upper wealth quintile (OR = 0.298; 95% 0.118–0.753) are less likely to visit PHCs for treatment. Also, increase in distance of PHC (OR = 0.203; 95% CI 0.076–0.539) reduces the likelihood of their visit outpatient care. People are 9.7 times (OR = 9.740; 95% CI 2.856–33.217) more likely to visit a PHCs that are better equipped in terms of human resources, equipment, and medicine. Conclusion The uptake of PHCs depends on several factors, which should be considered to ensure that all segments of society have equitable access to them. Through improved accessibility and quality of service, PHCs can be made more appealing to the larger population.

Although reality therapy has been effective in reducing symptoms of depression in adults, there is little research to support the use of reality therapy with deaf adults. This article demonstrates the use of reality therapy in reducing symptoms of depression in a deaf adult. Cultural competence is an important factor in the psychological treatment of individuals. It is important for clinicians to identify the cultural components that can play a part in the client's identity and treatment. The objective of this study is to highlight the importance of cultural competence and the use of reality therapy to help in meeting therapeutic goals.

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Background: We present a case of prescription practices in the Indian state of Rajasthan to demonstrate the effect of provider and system level factors, and their interactions on good prescription practices. We have presented two major dimensions of good prescription practice; first, completeness of prescription, a measure of adequacy; and second, appropriateness of prescription, a measure of quality of care. Method: We used mixed method to audit 2801 prescriptions, selected from 24 rural and 7 urban government Primary Health Centres of Rajasthan, India. The findings represent analysis of 97 percent of the selected prescriptions that were considered legible. The selected prescriptions ensure represent variance in patient categories, seasonality and number of OPD foot fall across days in a week. Semi-structured in-depth interviews, followed by Focused Group Discussion with providers was undertaken to obtain insights about facilitators and barriers to good prescription practices. We compared descriptive statistics across quintiles on adequacy indicators to understand variations around provider and system level factors; multilevel logistic regression model was used to obtain the adjusted effect. To assess appropriateness of quality of care, we evaluated 783 prescriptions that had adequate information to compare factors impacting QoC across quintiles. Finally, findings from the FGD was used to substantiate findings from the quantitative analysis. Result: We found that prescription practices are outcomes of both provider and system level factors, and their interactions. The documentation of patient complaint, examination findings largely depends on system level factors; 59 percent and 38 percent, respectively. The treatment adequacy is largely associated with patient category. Ownership compliance of the doctors, measured in terms of their signature in the prescriptions, emerged as an important factor determining both adequacy and accuracy of prescriptions. We also found that treatment appropriateness, measured in terms of QoC, depends on both provider and system level factors. A conducive environment and trained provider are more likely to provide adequate and appropriate treatment. It is also observed that higher patient load is not a counter-productive to treatment appropriateness. Out of 783 legible prescriptions that were assessed for its appropriateness, only 36 percent were found inappropriate in terms of their documented justification for the treatment advised. Conclusion: There is a need to focus on provider and system level factors to improve prescription practices in primary health care. We recommend that institutional strengthening at systemic and provider level using innovative ways; such as task shifting to nurses as physician assistants, and reducing administrative activities of physicians to enhance focus on clinical work can propel better prescription practice.