The spectrum of community activities of medical assistants in primary health care institutions: current realities and directions for improvement
Keywords:
community activity, primary health care, Republicof Moldova, improvement directionsAbstract
The increasing prevalence of chronic diseases and the aging population are putting immense pressure on family medicine. Community health care is currently one of the ways in which the health system could serve as a suitable solution to reduce the pressure. The study aims to assess the knowledge, attitudes and practices of primary health care nurses regarding the implementation of community activities in the Republic of Moldova. The methodology consisted of a review of the literature on the spectrum of community activities of nurses. Based on published data, a questionnaire was developed and validated. The questionnaires were completed online by primary healthcare nurses in the Republic of Moldova between June and September 2025. The results of this study provide evidence that 119 (45.9%) family health nurses out of 259 respondents included in the research group know the definition of community care and are aware of the positive impact on health of these interventions. The attitude towards community activity demonstrated that almost two thirds of the nurses 152 cases (58.7%), would be receptive to participating in the development of a community activity and could improve the approach to chronic diseases. The implementation of community activities is considered positively by almost half of the respondents. The conclusions of the research can serve as a benchmark for the development of institutional policies related to the satisfaction of patient care services in the community, as well as establishing directions for improvement by forming clear policies regarding the responsibilities of the community nurse, the formation and institutionalization of real interdisciplinary teams.
References
1. Humbert, M., Kovacs, G., Hoeper, M.M., et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. European Heart Journal. 2022;43(38):3618-3731. https://doi.org/10.1093/eurheartj/ehac237
2. Diaconu, N., et al. Post-pulmonary embolism syndrome: long-term complications of pulmonary embolism. Moldovan Medical Journal. 2023;66(1):44-51. https://doi.org/10.52418/moldovan-med-j.66-1.23.08
3. Luijten, D., de Jong, C.M.M., Ninaber, M.K., et al. Post-Pulmonary Embolism Syndrome and Functional Outcomes after Acute Pulmonary Embolism. Seminars in Thrombosis and Hemostasis. 2023;49(8):848-860. https://doi.org/10.1055/s-0042-1749659
4. Kirchberger, I., Fischer, S., Berghaus, T.M., et al. Dyspnea after a first episode of pulmonary embolism: prevalence, predictors and long-term associations with health-related quality of life. Frontiers in Cardiovascular Medicine. 2025;12:1595705. https://doi.org/10.3389/fcvm.2025.1595705
5. Farmakis, I.T., Keller, K., Barco, S., et al. From acute pulmonary embolism to post-pulmonary embolism sequelae. VASA. 2022;52(1):29-37. https://doi.org/10.1024/0301-1526/a001042
6. Morris, T., Fernandes, T., Channick, R. Evaluation of dyspnea and exercise intolerance after acute pulmonary embolism. Chest. 2023;163(4):933-941. https://doi.org/10.1016/j.chest.2022.06.036
7. Shah, K.P., Lee, C., McBane, R.D., et al. Post-Pulmonary Embolism Syndrome - A Diagnostic Dilemma and Challenging Management. Mayo Clinic Proceedings. 2024;99(12):1965-1982. https://doi.org/10.1016/j.mayocp.2024.07.008
8. Alblas, H., van Kan, C., van het Westeinde, S.C., et al. Persistent dyspnea after acute pulmonary embolism is related to perfusion defects and lower long-term quality of life. Thrombosis Research. 2022;219:89-94. https://doi.org/10.1016/j.thromres.2022.09.008
9. Vanaken, G., Wieczorek, D., Rubick, D., et al. Cardiopulmonary exercise testing following acute pulmonary embolism: systematic review and pooled analysis of global studies. Pulmonary Circulation. 2024;14(4):e12451. https://doi.org/10.1002/pul2.12451
10. Mounsey, L.A., et al. Cardiopulmonary exercise testing in people with persistent dyspnea after pulmonary embolism. Annals of the American Thoracic Society. 2023;20(10):1528-1530. https://doi.org/10.1513/AnnalsATS.202302-108RL
11. Khilzi, K., Piccari, L., Franco, G., et al. Cardiopulmonary exercise testing with simultaneous echocardiography after pulmonary embolism. Pulmonary Circulation. 2025;15(1):e70045. https://doi.org/10.1002/pul2.70045
12. Mali, R.M.A., Ninaber, M.K., van Mens, T.E., et al. Key elements of follow-up care after acute pulmonary embolism focusing on long-term sequelae: a Delphi study among European experts. European Heart Journal. Quality of Care & Clinical Outcomes. 2025;11(7):1137-1143. https://doi.org/10.1093/ehjqcco/qcaf053
13. Farmakis, I.T., Valerio, L., Barco, S., et al. Follow-up algorithm for detecting chronic sequelae of pulmonary embolism: diagnostic performance and possible limitations. Journal of Thrombosis and Haemostasis. 2025;23(12):S1538-7836(25)00912-2.
https://doi.org/10.1016/j.jtha.2025.11.029
14. Coquoz, N., Stolz, D., Popov, V., et al. Patient characteristics associated with dyspnea after an acute pulmonary embolism. European Respiratory Journal. 2025;66(suppl 69):PA1934. https://doi.org/10.1183/13993003.congress-2025.PA1934
15. Strategia națională de sănătate "Sănătatea - 2030", nr. 387 din 14-06-2023. Monitorul Oficial. 2023;302-305:700. https://www.legis.md/cautare/getResults?doc_id=138493&lang=ro
16. Mosteiro Miguéns, et al. Knowledge, attitudes, and practice of primary care professionals regarding community activities: a descriptive study. Family Practice. 2024;41(5):493-500. https://pmc.ncbi.nlm.nih.gov/articles/PMC11809258/
17. Ordinul Ministerului Sănătății privind asistența medicală primară nr. 925 din 15-10-2025. Monitorul Oficial. 2025;551-552:972. https://www.legis.md/cautare/getResults?doc_id=151464&lang=ro
18. Asistentele medicale comunitare din 7 raioane ale țării au participat la instruiri privind abordarea holistică a sănătății. 2021. https://viatasan.md/asistentelemedicale-comunitare-din-7-raioane-ale-tarii-au-participat-privind-abordarea-holistica-a-sanatatii/
19. Borșci, A., Curocichin, G. Spectrul activităților comunitare ale asistenților medicali din instituțiile de asistență medicală primară: realități curente și direcții de ameliorare. Nursing. 2025;(42):95. ISSN 3082-1630
20. Nursing comunitar - definiții, cadrul legislativ. UMF Craiova. 2024. https://suportcursonline.umfcv.ro/
21. Ernstmeyer, K., Christman, E., et al. Nursing: Mental Health and Community Concepts. 2022. https://www.ncbi.nlm.nih.gov/books/NBK590038/
22. McDonald, L. Florence Nightingale and public health policy: Theory, activism and public administration. 2006. https://cwfn.uoguelph.ca/nursing-health-care/fnand-public-health-policy/ https://doi.org/10.51644/9780889205420
23. Whittaker, R., et al. Mobile phone-based interventions for smoking cessation. Cochrane Database of Systematic Reviews. 2016;(4):CD006611. https://doi.org/10.1002/14651858.CD006611.pub4
24. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. National Academies Press. 2021. https://nap.nationalacademies.org/catalog/25982/
25. World Health Organization. Social determinants of health. 2024. https://www.who.int/health-topics/social-determinants-of-health
26. WHO Regional Office for Europe. Review of social determinants and the health divide in the WHO European Region. 2022. https://iris.who.int/handle/10665/363389
27. CDC. A healthy community is a prepared community. 2015. https://blogs.cdc.gov/publichealthmatters/2015/09/a-healthy-community-is-a-prepared-community/
28. Healthy People 2030. Social determinants of health. U.S. DHHS. 2024. https://health.gov/healthypeople/objectives-and-data/social-determinants-health
29. Mathieson, A., et al. Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing. Journal of Advanced Nursing. 2019;75(5):1141-1154. https://doi.org/10.1111/jan.13945
30. Mosteiro Miguéns, et al. Community Activities in Primary Care: A Literature Review. Journal of Primary Care & Community Health. 2024;15. https://doi.org/10.1177/21501319231223362
31. Pawłowski, L., et al. Nurse-led lifestyle counseling in primary care. Frontiers in Public Health. 2024;12:1301982. https://doi.org/10.3389/fpubh.2024.1301982
32. WHO. World report on ageing and health. 2015. https://www.who.int/publications/i/item/9789241565042
33. Pellerine, L.P., et al. Health care providers' perspectives on promoting physical activity. IJERPH. 2022;19(15):9466.
Downloads
Published
Issue
Section
License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.



