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Kojima N, Klausner JD. Virtual House Calls: Telemedicine and Reforming the Health Care Delivery Model with Strategies Implemented in a Novel Coronavirus Pandemic. J Gen Intern Med 2020; 35:2243. [PMID: 32367391 PMCID: PMC7197919 DOI: 10.1007/s11606-020-05867-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Noah Kojima
- Department of Medicine, University of California Los Angeles, Los Angeles, 90095, USA.
| | - Jeffrey D Klausner
- Department of Medicine, University of California Los Angeles, Los Angeles, 90095, USA
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Affiliation(s)
- Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kamal R Mahtani
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Abstract
The Covid-19 pandemic has altered the shape of medicine, making in-person interactions risky for both patients and health care workers. Now, before scheduling in-person appointments or procedures, physicians are forced to reconsider if they are truly necessary. The pandemic has thus thrown into relief the difference between evidence-based medical care and traditional aspects of care that lack a strong evidentiary component. In this essay, we demonstrate how this has played out in prenatal care, as well as in other aspects of medical care, during the pandemic. The extent to which these changes will persist beyond the most emergent phases of the pandemic is not clear, though insurance reimbursement practices and patient expectations will be determining factors. One thing, however, is certain: the longer the pandemic continues, the more difficult it will be for providers and patients to return to pre-Covid norms.
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Feigin VL, Brainin M, Norrving B, Gorelick PB, Dichgans M, Wang W, Pandian JD, Martins SCO, Owolabi MO, Wood DA, Hankey GJ. What Is the Best Mix of Population-Wide and High-Risk Targeted Strategies of Primary Stroke and Cardiovascular Disease Prevention? J Am Heart Assoc 2020; 9:e014494. [PMID: 31983323 PMCID: PMC7033901 DOI: 10.1161/jaha.119.014494] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/05/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Valery L. Feigin
- National Institute for Stroke and Applied NeurosciencesSchool of Public Health and Psychosocial StudiesFaculty of Health and Environmental SciencesAUT UniversityAucklandNew Zealand
| | - Michael Brainin
- Department of Neuroscience and Preventive MedicinePresident of the World Stroke OrganizationDanube University KremsAustria
| | - Bo Norrving
- Department of Clinical SciencesDepartment of NeurologySkåne University HospitalLund UniversityLundSweden
| | - Philip B. Gorelick
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIL
- Population Health Research InstituteMcMaster University of Health Sciences and Hamilton UniversityHamiltonOntarioCanada
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD)University HospitalLudwig‐Maximilians‐Universität LMUMunichGermany
- Munich Cluster of Systems Neurology (SyNergy)MunichGermany
| | - Wenzhi Wang
- Beijing Neurosurgical InstituteCapital Medical UniversityBeijingPeople's Republic of China
- National Office for CVD Prevention and ControlNational Health CommissionBeijingChina
| | | | | | - Mayowa O. Owolabi
- Center for Genomic and Precision MedicineUniversity of IbadanIbadanOyoNigeria
- University College HospitalIbadanOyoNigeria
- Blossom Center for NeurorehabilitationIbadanNigeria
| | - David A. Wood
- National Heart and Lung InstituteImperial College LondonLondonUnited Kingdom
- National Institute for Prevention and Cardiovascular HealthNational University of IrelandGalwayIreland
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Frazer K. Health checks have a limited effect on reducing morbidity and mortality in asymptomatic populations. Evid Based Nurs 2020; 23:32. [PMID: 31154358 DOI: 10.1136/ebnurs-2019-103094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Kate Frazer
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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56
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Nicholson BD, Aveyard P, Bankhead CR, Hamilton W, Hobbs FDR, Lay-Flurrie S. Determinants and extent of weight recording in UK primary care: an analysis of 5 million adults' electronic health records from 2000 to 2017. BMC Med 2019; 17:222. [PMID: 31783757 PMCID: PMC6883613 DOI: 10.1186/s12916-019-1446-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/02/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Excess weight and unexpected weight loss are associated with multiple disease states and increased morbidity and mortality, but weight measurement is not routine in many primary care settings. The aim of this study was to characterise who has had their weight recorded in UK primary care, how frequently, by whom and in relation to which clinical events, symptoms and diagnoses. METHODS A longitudinal analysis of UK primary care electronic health records (EHR) data from 2000 to 2017. Descriptive statistics were used to summarise weight recording in terms of patient sociodemographic characteristics, health professional encounters, clinical events, symptoms and diagnoses. Negative binomial regression was used to model the likelihood of having a weight record each year, and Cox regression to the likelihood of repeated weight recording. RESULTS A total of 14,049,871 weight records were identified in the EHR of 4,918,746 patients during the study period, representing 26,998,591 person-years of observation. Around a third of patients had a weight record each year. Forty-nine percent of weight records were repeated within a year with an average time to a repeat weight record of 1.92 years. Weight records were most often taken by nursing staff (38-42%) and GPs (37-39%) as part of a routine clinical care, such as chronic disease reviews (16%), medication reviews (6-8%) and health checks (6-7%), or were associated with consultations for contraception (5-8%), respiratory disease (5%) and obesity (1%). Patient characteristics independently associated with an increased likelihood of weight recording were as follows: female sex, younger and older adults, non-drinkers, ex-smokers, low or high BMI, being more deprived, diagnosed with a greater number of comorbidities and consulting more frequently. The effect of policy-level incentives to record weight did not appear to be sustained after they were removed. CONCLUSION Weight recording is not a routine activity in UK primary care. It is recorded for around a third of patients each year and is repeated on average every 2 years for these patients. It is more common in females with higher BMI and in those with comorbidity. Incentive payments and their removal appear to be associated with increases and decreases in weight recording.
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Affiliation(s)
- B D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK.
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
| | - C R Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
| | - W Hamilton
- Medical School, University of Exeter, Exeter, UK
| | - F D R Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
| | - S Lay-Flurrie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
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58
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Bernstorff M, Deichgræber P, Bruun NH, Dalsgaard EM, Fenger-Grøn M, Lauritzen T. A Randomised Trial Examining Cardiovascular Morbidity and All-Cause Mortality 24 years Following General Health Checks: the Ebeltoft Health Promotion Project (EHPP). BMJ Open 2019; 9:e030400. [PMID: 31662372 PMCID: PMC6830618 DOI: 10.1136/bmjopen-2019-030400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/06/2019] [Accepted: 10/07/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Global prevalence of risk factors for cardiovascular disease (CVD) and all-cause mortality is increasing. Treatments are available but can only be implemented if individuals at risk are identified. General health checks have been suggested to facilitate this process. OBJECTIVES To examine the long-term effect of population-based general health checks on CVD and all-cause mortality. DESIGN AND SETTING The Ebeltoft Health Promotion Project (EHPP) is a parallel randomised controlled trial in a Danish primary care setting. PARTICIPANTS The EHPP enrolled individuals registered in the Civil Registration System as (1) inhabitants of Ebeltoft municipality, (2) registered with a general practitioner (GP) participating in the study and (3) aged 30-49 on 1 January 1991. A total of 3464 individuals were randomised as invitees (n=2000) or non-invitees (n=1464). Of the invitees, 493 declined. As an external control group, we included 1 511 498 Danes living outside the municipality of Ebeltoft. INTERVENTIONS Invitees were offered a general health check and, if test-results were abnormal, recommended a 15-45 min consultation with their GP. Non-invitees in Ebeltoft received a questionnaire at baseline and were offered a general health check at year 5. The external control group, that is, the remaining Danish population, received routine care only. OUTCOME MEASURES HRs for CVD and all-cause mortality. RESULTS Every individual randomised was analysed. When comparing invitees to non-invitees within the municipality of Ebeltoft, we found no significant effect of general health checks on CVD (HR=1.11 (0.88; 1.41)) or all-cause mortality (HR=0.93 (0.75; 1.16)). When comparing invitees to the remaining Danish population, we found similar results for CVD (adjusted HR=0.99 (0.86; 1.13)) and all-cause mortality (adjusted HR=0.96 (0.85; 1.09)). CONCLUSION We found no effect of general health checks offered to the general population on CVD or all-cause mortality. TRIAL REGISTRATION NUMBER NCT00145782; 2015-57-0002; 62908, 187.
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Affiliation(s)
- Martin Bernstorff
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Pia Deichgræber
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Henrik Bruun
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Else-Marie Dalsgaard
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Morten Fenger-Grøn
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Torsten Lauritzen
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
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Mahase E. Health checks: no convincing evidence in favour exists, argue academic GPs. BMJ 2019; 366:l5504. [PMID: 31506267 DOI: 10.1136/bmj.l5504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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60
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Kamstrup-Larsen N, Dalton SO, Broholm-Jørgensen M, Larsen LB, Thomsen JL, Johansen C, Tolstrup JS. Using general practitioners to recruit individuals with low socioeconomic position to preventive health checks is feasible: a cross sectional study. Scand J Prim Health Care 2019; 37:294-301. [PMID: 31286817 PMCID: PMC6713093 DOI: 10.1080/02813432.2019.1639901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/31/2019] [Indexed: 02/03/2023] Open
Abstract
Objective: To test whether demographic and health-related characteristics are associated with non-attendance of preventive health checks offered to individuals with low levels of education using proactive recruitment by the general practitioners. Design: A cross-sectional study. Setting: 32 general practice clinics in Copenhagen, Denmark. Subjects: A total of 549 individuals aged 45-64, with low levels of education, enrolled in the intervention group of a randomised controlled trial on preventive health checks offered by general practitioner. Main outcome measures: Non-attendance of the preventive health checks. Methods: (i) Descriptive characteristics of attendees and non-attendees and (ii) crude and adjusted multi-level logistic regression to examine associations of individual characteristics with non-attendance of preventive health checks. Results: Overall, 33% did not attend the prescheduled preventive health checks at their general practitioners. Non-attendees were more likely to live without a partner, be of non-Western origin, be daily smokers, have poor self-rated health, have higher pulmonary symptoms score, have increased level of stress, have low levels of self-efficacy, have metabolic risk factors or non-communicable diseases and have had no contact with their general practitioner within the past year. Conclusion: The findings suggest that, it is feasible to use general practitioners for recruiting individuals for preventive health checks. However, even in a trial targeting individuals with low levels of education, there are differences between attendees and non-attendees, with a more adverse health behaviour profile and worse health status observed among the non-attendees. KEY POINTS Current awareness • Non-attendance of preventive health checks offered to the general population is associated with low socioeconomic position and adverse health behaviours. Main statements • It is feasible to use general practitioners proactively in recruitment to preventive health checks offered to individuals with low socioeconomic positions. • In a trial targeting individuals with low levels of education, there were differences between attendees and non-attendees. • Non-attendance was associated with daily smoking, poor self-rated health, high stress and no contact with the general practitioner within the last year.
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Affiliation(s)
- Nina Kamstrup-Larsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship Research Unit, the Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | | | - Lars Bruun Larsen
- Research Unit of General Practice in Odense, University of Southern Denmark, Denmark
| | - Janus Laust Thomsen
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Christoffer Johansen
- Survivorship Research Unit, the Danish Cancer Society Research Center, Copenhagen, Denmark
- Late Effect Research Unit CASTLE, Finsen Center, Rigshospitalet, Copenhagen, Denmark
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Sommer I, Titscher V, Teufer B, Klerings I, Nußbaumer-Streit B, Szelag M, Affengruber L, Wagner G, Glechner A, Kien C, Ebenberger A, Schiller-Frühwirth I, Dorner TE, Siebenhofer A, Haditsch B, Bachler H, Siebert U, Gartlehner G. [Evidence-based recommendations for the revision of the Austrian periodic health examination]. Wien Med Wochenschr 2019; 169:339-349. [PMID: 31187373 DOI: 10.1007/s10354-019-0699-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/15/2019] [Indexed: 12/27/2022]
Abstract
The Austrian periodic health examination (PHE) was introduced in 1974 as a health insurance benefit and was redesigned for the last time in 2005. Therefore, the aim of this work was to revise the scientific basis of the PHE using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. We updated the scientific evidence of examinations and consultations that are currently part of the PHE and searched and integrated new examinations. We assessed the expectations of the population towards the PHE in three focus groups. A panel of experts developed evidence-based recommendations for the revised PHE. They formulated 26 recommendations on 20 target diseases or risk factors. In comparison to the previous PHE, the panel added screening for abdominal aortic aneurysm, osteoporotic fracture risk, and chronic kidney disease to the recommendations, while screening for asymptomatic bacteriuria, screening for iron deficiency/pernicious anaemia, and risk identification of glaucoma should no longer be included.
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Affiliation(s)
- Isolde Sommer
- Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Universität für Weiterbildung, Krems, Österreich.
| | - Viktoria Titscher
- Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Universität für Weiterbildung, Krems, Österreich
| | - Birgit Teufer
- Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Universität für Weiterbildung, Krems, Österreich
| | - Irma Klerings
- Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Universität für Weiterbildung, Krems, Österreich
| | - Barbara Nußbaumer-Streit
- Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Universität für Weiterbildung, Krems, Österreich
| | - Monika Szelag
- Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Universität für Weiterbildung, Krems, Österreich
| | - Lisa Affengruber
- Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Universität für Weiterbildung, Krems, Österreich
| | - Gernot Wagner
- Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Universität für Weiterbildung, Krems, Österreich
| | - Anna Glechner
- Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Universität für Weiterbildung, Krems, Österreich
| | - Christina Kien
- Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Universität für Weiterbildung, Krems, Österreich
| | - Agnes Ebenberger
- Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Universität für Weiterbildung, Krems, Österreich
| | | | - Thomas E Dorner
- Zentrum für Public Health, Abteilung für Sozial- und Präventivmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Andrea Siebenhofer
- Institut für Allgemeinmedizin und evidenzbasierte Versorgungsforschung, Medizinische Universität Graz, Graz, Österreich.,Institut für Allgemeinmedizin, Goethe-Universität, Frankfurt am Main, Deutschland
| | | | | | - Uwe Siebert
- Institut für Public Health, Medical Decision Making und Health Technology Assessment, UMIT - Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik, Hall i.T., Österreich.,Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gerald Gartlehner
- Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Universität für Weiterbildung, Krems, Österreich.,Research Triangle Institute International, Raleigh, NC, USA
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