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Lutaud R, Cortaredona S, Delorme L, Peretti-Watel P, Mirouse J, Borg M, Cattaneo L, Thery D, Gentile G, Pradier C, Irit T, Brouqui P, Tardieu S, Carles M, Gentile S. COVID-19 patient experiences in prehospital pathways: a processual approach using life-events calendar method and state sequence analysis shows detrimental delays. Fam Med Community Health 2024; 12:e002447. [PMID: 38216208 PMCID: PMC10806557 DOI: 10.1136/fmch-2023-002447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES To our best knowledge, no study in France has comprehensively investigated the prehospital history of patients admitted for severe cases of COVID-19. 'Patients' voice is an excellent means to capture data on primary care pathways.We aimed to identify clusters of COVID-19 hospitalised patients with similar prehospital symptom sequences, and to test whether these clusters were associated with a higher risk of poor clinical outcomes. DESIGN Cross-sectional online survey using life-event calendars. SETTING All patients hospitalised for COVID-19 between September 2020 and May 2021 in the Infectious Disease Departments in Nice and in Marseilles in France. PARTICIPANTS 312 patients responded to the survey. MAIN OUTCOME MEASURES From the day of symptom onset to the day of hospitalisation, we defined a symptom sequence as the time-ordered vector of the successive symptom grades (grade 1, grade 2, grade 3). State sequence analysis with optimal matching was used to identify clusters of patients with similar symptom sequences. Multivariate logistic regressions were performed to test whether these clusters were associated with admission to intensive care unit (ICU) and COVID-19 sequelae after hospitalisation. RESULTS Three clusters of symptom sequences were identified among 312 complete prehospital pathways. A specific group of patients (29%) experienced extended symptoms of severe COVID-19, persisting for an average duration of 7.5 days before hospitalisation. This group had a significantly higher probability of being admitted to ICU (adjusted OR 2.01). They were less likely to know a loved one who was a healthcare worker, and more likely to have a lower level of education. Similarly, this group of patients, who were more likely to have previously visited the emergency room without exhibiting severe symptoms at that time, may have been inclined to postpone reassessment when their health worsened.Their relatives played a decisive role in their hospitalisation. CONCLUSION AND RELEVANCE This study highlights the negative impact of delayed hospitalisation on the health outcomes of French patients with severe COVID-19 symptoms during the first wave and underscores the influence of socioeconomic factors, such as lower education levels and limited connections to the medical field, on patients' experiences.
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Affiliation(s)
- Romain Lutaud
- Department of General Practice, Aix-Marseille University, Marseille, France
- ADES, Marseille, France
| | | | - Lea Delorme
- Assistance Publique- Hôpitaux de Marseille (AP-HM), Marseille, France
| | | | - Juliette Mirouse
- Department of General Practice, Aix-Marseille University, Marseille, France
| | - Manon Borg
- Department of General Practice, Aix-Marseille University, Marseille, France
| | - Lucie Cattaneo
- Assistance Publique- Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Didier Thery
- Department of General Practice, Aix-Marseille University, Marseille, France
| | - Gaetan Gentile
- Department of General Practice, Aix-Marseille University, Marseille, France
| | - Christian Pradier
- Department of Public Health, Archet University Hospital, Nice, France
| | - Touitou Irit
- Department of Public Health, Archet University Hospital, Nice, France
| | | | - Sophie Tardieu
- CEReSS - Health Service Research and Quality of life Center, Marseille, France
| | - Michel Carles
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Stéphanie Gentile
- CEReSS - Health Service Research and Quality of life Center, Marseille, France
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Hayward CJ, Batty JA, Westhead DR, Johnson O, Gale CP, Wu J, Hall M. Disease trajectories following myocardial infarction: insights from process mining of 145 million hospitalisation episodes. EBioMedicine 2023; 96:104792. [PMID: 37741008 PMCID: PMC10520333 DOI: 10.1016/j.ebiom.2023.104792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Knowledge of post-myocardial infarction (MI) disease risk to date is limited-yet the number of survivors of MI has increased dramatically in recent decades. We investigated temporally ordered sequences of all conditions following MI in nationwide electronic health record data through the application of process mining. METHODS We conducted a national retrospective cohort study of all hospitalisations (145,670,448 episodes; 34,083,204 individuals) admitted to NHS hospitals in England (1st January 2008-31st January 2017, final follow-up 27th March 2017). Through process mining, we identified trajectories of all major disease diagnoses following MI and compared their relative risk (RR) and all-cause mortality hazard ratios (HR) to a risk-set matched non-MI control cohort using Cox proportional hazards and flexible parametric survival models. FINDINGS Among a total of 375,669 MI patients (130,758 females; 34.8%) and 1,878,345 matched non-MI patients (653,790 females; 34.8%), we identified 28,799 unique disease trajectories. The accrual of multiple circulatory diagnoses was more common amongst MI patients (RR 4.32, 95% CI 3.96-4.72) and conferred an increased risk of death (HR 1.32, 1.13-1.53) compared with matched controls. Trajectories featuring neuro-psychiatric diagnoses (including anxiety and depression) following circulatory disorders were markedly more common and had increased mortality post MI (HR ranging from 1.11 to 1.73) compared with non-MI individuals. INTERPRETATION These results provide an opportunity for early intervention targets for survivors of MI-such as increased focus on the psychological and behavioural pathways-to mitigate ongoing adverse disease trajectories, multimorbidity, and premature mortality. FUNDING British Heart Foundation; Alan Turing Institute.
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Affiliation(s)
- Christopher J Hayward
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK
| | - Jonathan A Batty
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK
| | - David R Westhead
- Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK; School of Molecular and Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Owen Johnson
- School of Computing, Faculty of Engineering and Physical Sciences, University of Leeds, LS2 9JT, UK
| | - Chris P Gale
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | - Jianhua Wu
- Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK; Wolfson Institute of Population Health, Queen Mary University of London, London, E1 4NS, UK
| | - Marlous Hall
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK.
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Lyons J, Akbari A, Abrams KR, Azcoaga Lorenzo A, Ba Dhafari T, Chess J, Denaxas S, Fry R, Gale CP, Gallacher J, Griffiths LJ, Guthrie B, Hall M, Jalali-najafabadi F, John A, MacRae C, McCowan C, Peek N, O’Reilly D, Rafferty J, Lyons RA, Owen RK. Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005-2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individuals. THE LANCET REGIONAL HEALTH. EUROPE 2023; 32:100687. [PMID: 37520147 PMCID: PMC10372901 DOI: 10.1016/j.lanepe.2023.100687] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023]
Abstract
Background Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortality between socioeconomic groups in Wales, UK. Methods Population-wide electronic linked cohort study, following Welsh residents for up to 20 years (2000-2019). Chronic disease diagnoses were obtained from general practice and hospitalisation records using the CALIBER disease phenotype register. Multi-state models were used to examine trajectories of accrual of 132 diseases and mortality, adjusted for sex, age and area-level deprivation. Restricted mean survival time was calculated to measure time spent free of chronic disease(s) or mortality between socioeconomic groups. Findings In total, 965,905 individuals aged 5-104 were included, from a possible 2.9 m individuals following a 5-year clearance period, with an average follow-up of 13.2 years (12.7 million person-years). Some 673,189 (69.7%) individuals developed at least one chronic disease or died within the study period. From ages 10 years upwards, the individuals living in the most deprived areas consistently experienced reduced time between health states, demonstrating accelerated transitions to first and subsequent morbidities and death compared to their demographic equivalent living in the least deprived areas. The largest difference were observed in 10 and 20 year old males developing multimorbidity (-0.45 years (99% CI: -0.45, -0.44)) and in 70 year old males dying after developing multimorbidity (-1.98 years (99% CI: -2.01, -1.95)). Interpretation This study adds to the existing literature on health inequalities by demonstrating that individuals living in more deprived areas consistently experience accelerated time to diagnosis of chronic disease and death across all ages, accounting for competing risks. Funding UK Medical Research Council, Health Data Research UK, and Administrative Data Research Wales.
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Affiliation(s)
- Jane Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | - Keith R. Abrams
- Department of Statistics, University of Warwick, Coventry, UK
- Centre for Health Economics, University of York, York, UK
| | - Amaya Azcoaga Lorenzo
- Instituto Investigación Sanitaria Fundación Jimenez Diaz, Madrid, Spain
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Thamer Ba Dhafari
- Division of Informatics, Imaging and Data Science, School of Health Sciences, University of Manchester, Manchester, UK
| | - James Chess
- Swansea Bay Health Board, Morriston Hospital, Swansea, Wales, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
| | - Richard Fry
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | | | - John Gallacher
- Dementias Platform UK, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Lucy J. Griffiths
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Farideh Jalali-najafabadi
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Ann John
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | - Clare MacRae
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Niels Peek
- Division of Informatics, Imaging and Data Science, School of Health Sciences, University of Manchester, Manchester, UK
| | - Dermot O’Reilly
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - James Rafferty
- Swansea Trials Unit, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | - Ronan A. Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | - Rhiannon K. Owen
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
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Carrasco-Ribelles LA, Cabrera-Bean M, Danés-Castells M, Zabaleta-Del-Olmo E, Roso-Llorach A, Violán C. Contribution of Frailty to Multimorbidity Patterns and Trajectories: Longitudinal Dynamic Cohort Study of Aging People. JMIR Public Health Surveill 2023; 9:e45848. [PMID: 37368462 PMCID: PMC10365626 DOI: 10.2196/45848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/02/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Multimorbidity and frailty are characteristics of aging that need individualized evaluation, and there is a 2-way causal relationship between them. Thus, considering frailty in analyses of multimorbidity is important for tailoring social and health care to the specific needs of older people. OBJECTIVE This study aimed to assess how the inclusion of frailty contributes to identifying and characterizing multimorbidity patterns in people aged 65 years or older. METHODS Longitudinal data were drawn from electronic health records through the SIDIAP (Sistema d'Informació pel Desenvolupament de la Investigació a l'Atenció Primària) primary care database for the population aged 65 years or older from 2010 to 2019 in Catalonia, Spain. Frailty and multimorbidity were measured annually using validated tools (eFRAGICAP, a cumulative deficit model; and Swedish National Study of Aging and Care in Kungsholmen [SNAC-K], respectively). Two sets of 11 multimorbidity patterns were obtained using fuzzy c-means. Both considered the chronic conditions of the participants. In addition, one set included age, and the other included frailty. Cox models were used to test their associations with death, nursing home admission, and home care need. Trajectories were defined as the evolution of the patterns over the follow-up period. RESULTS The study included 1,456,052 unique participants (mean follow-up of 7.0 years). Most patterns were similar in both sets in terms of the most prevalent conditions. However, the patterns that considered frailty were better for identifying the population whose main conditions imposed limitations on daily life, with a higher prevalence of frail individuals in patterns like chronic ulcers &peripheral vascular. This set also included a dementia-specific pattern and showed a better fit with the risk of nursing home admission and home care need. On the other hand, the risk of death had a better fit with the set of patterns that did not include frailty. The change in patterns when considering frailty also led to a change in trajectories. On average, participants were in 1.8 patterns during their follow-up, while 45.1% (656,778/1,456,052) remained in the same pattern. CONCLUSIONS Our results suggest that frailty should be considered in addition to chronic diseases when studying multimorbidity patterns in older adults. Multimorbidity patterns and trajectories can help to identify patients with specific needs. The patterns that considered frailty were better for identifying the risk of certain age-related outcomes, such as nursing home admission or home care need, while those considering age were better for identifying the risk of death. Clinical and social intervention guidelines and resource planning can be tailored based on the prevalence of these patterns and trajectories.
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Affiliation(s)
- Lucía A Carrasco-Ribelles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- Signal Processing and Communications Group (SPCOM), Department of Signal Theory and Communications, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Mataró, Spain
- Grup de REcerca en Impacte de les Malalties Cròniques i les seves Trajectòries (GRIMTRA) (2021 SGR 01537), Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) (RD21/0016/0029), Instituto de Salud Carlos III, Madrid, Spain
| | - Margarita Cabrera-Bean
- Signal Processing and Communications Group (SPCOM), Department of Signal Theory and Communications, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Marc Danés-Castells
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Mataró, Spain
| | - Edurne Zabaleta-Del-Olmo
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- Grup de REcerca en Impacte de les Malalties Cròniques i les seves Trajectòries (GRIMTRA) (2021 SGR 01537), Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) (RD21/0016/0029), Instituto de Salud Carlos III, Madrid, Spain
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
- Nursing Department, Faculty of Nursing, Universitat de Girona, Girona, Spain
| | - Albert Roso-Llorach
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- Grup de REcerca en Impacte de les Malalties Cròniques i les seves Trajectòries (GRIMTRA) (2021 SGR 01537), Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) (RD21/0016/0029), Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Concepción Violán
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Mataró, Spain
- Grup de REcerca en Impacte de les Malalties Cròniques i les seves Trajectòries (GRIMTRA) (2021 SGR 01537), Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) (RD21/0016/0029), Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
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Klitgaard A, Ibsen R, Hilberg O, Løkke A. Study protocol: pneumonia and inhaled corticosteroid treatment patterns in chronic obstructive pulmonary disease - a cohort study using sequence analysis (PICCS). BMJ Open 2023; 13:e072685. [PMID: 37263696 DOI: 10.1136/bmjopen-2023-072685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Treatment with inhaled corticosteroids (ICS) is a widely used treatment in chronic obstructive pulmonary disease. The main effects include a reduction in the number of exacerbations and, for some patients, an increase in expected mortality. Unfortunately, the treatment is also linked to an increased risk of pneumonia, and very little is known about which patients experience this increased risk. There is a need for identification of patient characteristics associated with increased risk of pneumonia and treatment with ICS. METHODS AND ANALYSIS This is a register-based cohort study that uses the nationwide Danish registers. Data from several registers in the years 2008-2018 will be merged on an individual level using the personal identification numbers that are unique to every citizen in Denmark. Clusters based on pneumonia incidence and ICS treatment patterns will be explored with a sequence analysis in a 3-year follow-up period. ETHICS AND DISSEMINATION This is a register-based study and research ethics approval is not required according to Danish Law and National Ethics Committee Guidelines. The results will be submitted to peer-reviewed journals and reported at appropriate national and international meetings.
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Affiliation(s)
- Allan Klitgaard
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Ole Hilberg
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Løkke
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Sado K, Keenan K, Manataki A, Kesby M, Mushi MF, Mshana SE, Mwanga J, Neema S, Asiimwe B, Bazira J, Kiiru J, Green DL, Ke X, Maldonado-Barragán A, Abed Al Ahad M, Fredricks K, Gillespie SH, Sabiiti W, Mmbaga BT, Kibiki G, Aanensen D, Smith VA, Sandeman A, Sloan DJ, Holden MT. Treatment seeking behaviours, antibiotic use and relationships to multi-drug resistance: A study of urinary tract infection patients in Kenya, Tanzania and Uganda. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.04.23286801. [PMID: 36945627 PMCID: PMC10029025 DOI: 10.1101/2023.03.04.23286801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Antibacterial resistance (ABR) is a major public health threat. An important accelerating factor is treatment-seeking behaviours, including inappropriate antibiotic (AB) use. In many low- and middle-income countries (LMICs) this includes taking ABs with and without prescription sourced from various providers, including health facilities and community drug sellers. However, investigations of complex treatment-seeking, AB use and drug resistance in LMICs are scarce. The Holistic Approach to Unravel Antibacterial Resistance in East Africa (HATUA) Consortium collected questionnaire and microbiological data from 6,827 adult outpatients with urinary tract infection (UTI)-like symptoms presenting at healthcare facilities in Kenya, Tanzania and Uganda. Among 6,388 patients we analysed patterns of self-reported treatment seeking behaviours ('patient pathways') using process mining and single-channel sequence analysis. Of those with microbiologically confirmed UTI (n=1,946), we used logistic regression to assessed the relationship between treatment seeking behaviour, AB use, and likelihood of having a multi-drug resistant (MDR) UTI. The most common treatment pathways for UTI-like symptoms included attending health facilities, rather than other providers (e.g. drug sellers). Patients from the sites sampled in Tanzania and Uganda, where prevalence of MDR UTI was over 50%, were more likely to report treatment failures, and have repeated visits to clinics/other providers, than those from Kenyan sites, where MDR UTI rates were lower (33%). There was no strong or consistent relationship between individual AB use and risk of MDR UTI, after accounting for country context. The results highlight challenges East African patients face in accessing effective UTI treatment. These challenges increase where rates of MDR UTI are higher, suggesting a reinforcing circle of failed treatment attempts and sustained selection for drug resistance. Whilst individual behaviours may contribute to the risk of MDR UTI, our data show that factors related to context are stronger drivers of ABR.
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Affiliation(s)
- Keina Sado
- University of St Andrews, St Andrews, UK
| | | | | | - Mike Kesby
- University of St Andrews, St Andrews, UK
| | - Martha F Mushi
- Catholic University Of Health And Allied Sciences, Mwanza, Tanzania
| | - Stephen E Mshana
- Catholic University Of Health And Allied Sciences, Mwanza, Tanzania
| | - Joseph Mwanga
- Catholic University Of Health And Allied Sciences, Mwanza, Tanzania
| | | | | | - Joel Bazira
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - John Kiiru
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Xuejia Ke
- University of St Andrews, St Andrews, UK
| | | | | | | | | | | | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi Tanzania
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7
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Rotaeche del Campo R, Gorroñogoitia Iturbe A. Reflexiones sobre la atención primaria del siglo xxi. ATENCIÓN PRIMARIA PRÁCTICA 2022; 4. [PMCID: PMC9707514 DOI: 10.1016/j.appr.2022.100159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
La atención primaria debe de afrontar los nuevos desafíos del siglo xxi que ya han comenzado con la pandemia de la covid-19. Desafíos que tienen que ver con una nueva realidad sociosanitaria caracterizada por un aumento de la prevalencia de la comorbilidad y fragilidad ligada al envejecimiento y al impacto de los determinantes de la salud; cambios en la población con pacientes más informados y que reclaman participar en las decisiones que afectan a su salud en una sociedad cada vez más digitalizada. En ese contexto la atención primaria debe de resolver nuevos retos como cambiar su funcionamiento con equipos más cohesionados que puedan incorporar nuevos perfiles que aporten valor y donde exista un compromiso con la docencia y la investigación. La gestión de todos estos desafíos requiere que los profesionales que trabajan en atención primaria en el siglo xxi profundicen en sus competencias mirando más allá de las consultas de su centro de salud. Competencias como la selección y el uso del mejor conocimiento, el pensamiento crítico, el uso de la comunicación para acercarse a los valores y las preferencias de los pacientes, la toma de decisiones compartida y la conciencia social. Para que todos estos cambios se puedan realizar hace falta un impulso institucional con múltiples medidas insistentemente reclamadas por los profesionales. Entre las que están, en primer lugar, una mayor inversión en personal y equipamiento, así como apostar por modelos organizativos avalados por la evidencia destinados a obtener una atención más coordinada e integrada entre la atención primaria, el hospital, la salud mental, la salud pública y los servicios sociales la utilización juiciosa de las soluciones de la e-salud o la incorporación de un área de conocimiento sobre atención primaria en la universidad.
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Affiliation(s)
- Rafael Rotaeche del Campo
- Grupo MBE de semFYC, Centro de salud de Alza, OSI Donostia-Osakidetza, San Sebastián, España,Autor para correspondencia
| | - Ana Gorroñogoitia Iturbe
- Unidad Docente Multiprofesional, Atención Familiar y Comunitaria, Grupo MBE de semFYC, Bizkaia, España
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