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Dragun AJ, Fabiano AS, Weber T, Hall K, Bagley CA. Evaluation of ERAS protocol implementation on complex spine surgery complications and length of stay: a single institution study. Spine J 2024; 24:1811-1816. [PMID: 38838854 DOI: 10.1016/j.spinee.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/24/2024] [Accepted: 05/27/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND CONTEXT With the goal of improving patient outcomes, the Integrated Spine Center at UT Southwestern Medical Center implemented an enhanced recovery after surgery (ERAS) protocol which includes pre- and postsurgery guidelines. Numerous studies have shown benefit of implementation of ERAS protocols to standardize perioperative care in line with best practices; however, the literature on complication rates, LOS, and readmissions shows mixed results. PURPOSE The goal of this study was to investigate the impact of the ERAS protocol implementation on complication rates in the perioperative period, as well as hospital and ICU length of stay and hospital re-admission rates. STUDY DESIGN/SETTING A retrospective cohort study was performed on all patients who underwent spine surgery between September 2016 and September 2021 at a single institution. Patients who met inclusion criteria were divided into non-ERAS and ERAS groups, and comparative statistics were used to evaluate ERAS protocol effectiveness. PATIENT SAMPLE All patients who underwent spine surgery at UT Southwestern between September 2016 and September 2021 were evaluated for inclusion in the study. The patient sample was further refined to include only complex patient cases which were able to receive the full ERAS protocol (nonemergent admissions). OUTCOME MEASURES Presence of absence of postoperative complications including surgical site infection, AKI, DVT, MI, sepsis, pneumonia, PE, stroke, shock, and other complications were compared between groups, as were hospital and ICU length of stay, and 7, 30, and 90 day readmissions. Self-reported or functional measures were not used in outcome evaluation. METHODS A database of patient and surgery characteristics was built using an EMR query tool with spot checks performed by the authors. Control and treatment groups were matched for gender, age, BMI, ASA score, and surgery type. Total number of complication rates was compared between ERAS and non-ERAS groups, and comparative statistics were used to determine significance. RESULTS Significant differences between ERAS versus non-ERAS groups were found in rates of UTI (6.8% vs 3.1%, respectively; p=.031), constipation (20.6% vs 11.4%, respectively; p=.001), and any complications (31.4% vs 19.4%, respectively; p<.001). There was no significant difference in the rates of other complications, in length of hospital or ICU stay, or readmissions at 7, 30, and 90 days. CONCLUSIONS Implementation of the ERAS protocol did not decrease complication rates or length of stay, and ERAS patients had significantly higher rates of UTI, constipation, and any complications. There may have been confounding factors due to the impact of COVID-19 on delivery of care, as well as misalignment between ERAS goals and outcome measures.
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Affiliation(s)
- Anthony J Dragun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | - Alexander S Fabiano
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Theodore Weber
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Kristen Hall
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Carlos A Bagley
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Cheng A, Hart K, Baron A, Dollar E, Park B, DeVoe J, Herman E, Johnson J, Cohen DJ. Unbiased care, unequal outcomes: a nursing telehealth intervention reveals systematic inequities in COVID-19 care delivery. BMC Nurs 2024; 23:622. [PMID: 39237968 PMCID: PMC11378369 DOI: 10.1186/s12912-024-02270-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 08/16/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND The Covid Connected Care Center (C4), a low-barrier telephone nurse hotline, was developed at an academic medical center to increase access to healthcare information and services across the state of Oregon, including to those without a usual source of care. Other studies have demonstrated that telephone triage services can positively influence health behaviors, but it is not known how this effect is maintained across racial/ethnic groups. The objective of this study was to show that the C4 reached throughout the state of Oregon, was valuable to callers, and that recommendations given affected callers' subsequent health-related behaviors. METHODS This mixed-methods study, informed by the RE-AIM (Reach, Effectiveness, Addoption, Implementation and Maintenance) framework, assessed caller demographics and clinical care from March 30 2020 until September 8, 2021. Descriptive statistics, multivariable risk models and Zou's modified Poisson modeling were applied to electronic health record and call system data; An inductive approach was used for patient and staff experience surveys and semi-structured interviews. Approval was obtained from the OHSU Institutional Review Board (Study 00021413). RESULTS 145,537 telephone calls and 92,100 text-based contacts (61% and 39%, respectively) were included. Callers tended to not have a usual source of primary care and utilized recommended services. Emergency department utilization was minimal (1.5%). Racial or ethnic disparities were not detected in the recommendations, but Black (RR 0.92, CI 0.86-0.98) and Multiracial (RR 0.90 CI 0.81-0.99) callers were less likely than non-Hispanic white callers to receive a COVID-19 test. Participants in the post-call survey (n = 50) would recommend this service to friends or family. Interviews with callers (n = 9) revealed this was because they valued assistance translating general recommendations into a personalized care plan. C4 staff interviewed (n = 9) valued the opportunity to serve the public. The C4 was a trusted resource to the public and reached the intended audiences. However, disparities in access to COVID-19 testing persisted. CONCLUSIONS Nursing triage hotlines can guide caller behavior and be an effective part of a robust public health information infrastructure.
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Affiliation(s)
- Anthony Cheng
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.
| | - Kyle Hart
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| | - Andrea Baron
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Emily Dollar
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Brian Park
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Jen DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Eric Herman
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Julie Johnson
- Ambulatory Administration, Oregon Health & Science University, Portland, Oregon, USA
| | - Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Hambalek H, Matuz M, Ruzsa R, Papfalvi E, Nacsa R, Engi Z, Csatordai M, Soós G, Hajdú E, Csupor D, Benkő R. Returned Rate and Changed Patterns of Systemic Antibiotic Use in Ambulatory Care in Hungary after the Pandemic-A Longitudinal Ecological Study. Antibiotics (Basel) 2024; 13:848. [PMID: 39335021 PMCID: PMC11429041 DOI: 10.3390/antibiotics13090848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/21/2024] [Accepted: 09/03/2024] [Indexed: 09/30/2024] Open
Abstract
The COVID-19 pandemic affected the epidemiology of infectious diseases and changed the operation of health care systems and health care seeking behavior. Our study aimed to analyze the utilization of systemic antibiotics in ambulatory care in Hungary after the COVID-19 pandemic and compare it to the period before COVID. We defined three periods (24 months each): Before COVID, COVID, and After COVID. Monthly trends in systemic antibiotic (J01) use were calculated using the WHO ATC-DDD index and expressed as DDD/1000 inhabitants/day (DID) and number of exposed patients per active agent. The data were further categorized by the WHO AWaRe classification. In the After COVID period, we detected almost the same (11.61 vs. 11.11 DID) mean monthly use of systemic antibiotics in ambulatory care compared to the Before COVID period. We observed a decrease in the seasonality index in the After COVID period (46.86% vs. 39.86%). In the After COVID period, the use of cephalosporins and quinolones decreased significantly, while in the case of macrolides, a significant increase was observed compared to the Before COVID period, with excessive azithromycin use (66,869 vs. 97,367 exposed patients). This study demonstrated significant changes in the pattern of ambulatory care antibiotic use in Hungary.
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Affiliation(s)
- Helga Hambalek
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- University Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Mária Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- University Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Roxána Ruzsa
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- University Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Erika Papfalvi
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Róbert Nacsa
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- University Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Zsófia Engi
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Márta Csatordai
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- University Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Gyöngyvér Soós
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Edit Hajdú
- Department of Internal Medicine Infectiology Unit, Albert Szent-Györgyi Health Centre, University of Szeged, Állomás Street 1-3, 6725 Szeged, Hungary
| | - Dezső Csupor
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Ria Benkő
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- University Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
- Emergency Department, Albert Szent-Györgyi Health Centre, University of Szeged, Semmelweis Street 6, 6725 Szeged, Hungary
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Tu K, Lapadula MC, Apajee J, Bonilla AO, Baste V, Cuba-Fuentes MS, de Lusignan S, Flottorp S, Gaona G, Goh LH, Hallinan CM, Kristiansson RS, Laughlin A, Li Z, Ling ZJ, Manski-Nankervis JA, Ng APP, Scattini LF, Silva-Valencia J, Pace WD, Wensaas KA, Wong WCW, Zingoni PL, Westfall JM. Changes in reasons for visits to primary care after the start of the COVID-19 pandemic: An international comparative study by the International Consortium of Primary Care Big Data Researchers (INTRePID). PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003406. [PMID: 39173045 PMCID: PMC11341054 DOI: 10.1371/journal.pgph.0003406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 07/04/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND The COVID-19 pandemic has reshaped healthcare delivery worldwide. OBJECTIVE To explore potential changes in the reasons for visits and modality of care in primary care settings through the International Consortium of Primary Care Big Data Researchers (INTRePID). METHODS We conducted a cross-sectional, retrospective study from 2018-2021. We examined visit volume, modality, and reasons for visits to primary care in Argentina, Australia, Canada, China, Peru, Norway, Singapore, Sweden, and the USA. The analysis involved a comparison between the pre-pandemic and pandemic periods. RESULTS There were more than 215 million visits from over 38 million patients during the study period in INTRePID primary care settings. Most INTRePID countries experienced a decline in monthly visit rates during the first year of the pandemic, with rate ratios (RR) and 95% confidence intervals (CI) ranging from RR:0.57 (95%CI:0.49-0.66) to RR:0.90 (95%CI:0.83-0.98), except for in Canada (RR:0.99, 95%CI:0.94-1.05) and Norway (RR:1.00, 95%CI:0.92-1.10), where rates remained stable and in Australia where rates increased (RR:1.19, 95%CI:1.11-1.28). Argentina, China, and Singapore had limited or no adoption of virtual care, whereas the remaining INTRePID countries varied in the extent of virtual care utilization. In Peru, virtual visits accounted for 7.34% (95%CI:7.33%-7.35%) of all interactions in the initial year of the pandemic, dipping to 5.22% (95%CI:5.21%-5.23%) in the subsequent year. However, in Canada 75.30% (95%CI:75.20%-75.40%) of the visits in the first year were virtual, decreasing to 62.77% (95%CI:62.66%-62.88%) in the second year. Diabetes, hypertension and/or hyperlipidemia and general health exams were in the top 10 reasons for visits in 2019 for all countries. Anxiety, depression and/or other mental health related reasons were among the top 10 reasons for virtual visits in all countries that had virtual care. CONCLUSIONS The pandemic resulted in changes in reasons for visits to primary care, with virtual care mitigating visit volume disruptions in many countries.
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Affiliation(s)
- Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- North York General Hospital, Toronto, Canada
- Toronto Western Hospital, Family Health Team, University Health Network, Toronto, Canada
| | - María C. Lapadula
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Jemisha Apajee
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | | | - Valborg Baste
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - María S. Cuba-Fuentes
- Center for Research in Primary Health Care (CINAPS), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Signe Flottorp
- Norwegian Institute of Public Health, Oslo, Norway
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Gabriela Gaona
- DARTNet Institute, Aurora, Colorado, United States of America
| | - Lay Hoon Goh
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Christine M. Hallinan
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
| | | | - Adrian Laughlin
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
| | - Zhuo Li
- Department of Family Medicine and Primary Care, University of Hong Kong, Shenzhen Hospital, Shenzhen, China
| | - Zheng J. Ling
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jo-Anne Manski-Nankervis
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
- Primary Care and Family Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Amy P. P. Ng
- Department of Family Medicine and Primary Care, University of Hong Kong, Shenzhen Hospital, Shenzhen, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Luciano F. Scattini
- Ministry of Health of the Autonomous City of Buenos Aires, Autonomous City of Buenos Aires, Argentina
| | | | - Wilson D. Pace
- DARTNet Institute, Aurora, Colorado, United States of America
| | - Knut-Arne Wensaas
- Research Unit for General Practice, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - William C. W. Wong
- Department of Family Medicine and Primary Care, University of Hong Kong, Shenzhen Hospital, Shenzhen, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Paula L. Zingoni
- Ministry of Health of the Autonomous City of Buenos Aires, Autonomous City of Buenos Aires, Argentina
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Rison SCG, Redfern OC, Mathur R, Dostal I, Carvalho C, Raisi-Estabragh Z, Robson J. COVID-19 pandemic impact on hypertension management in North East London: an observational cohort study using electronic health records. BMJ Open 2024; 14:e083497. [PMID: 39107017 PMCID: PMC11308888 DOI: 10.1136/bmjopen-2023-083497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 07/19/2024] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVE There are established inequities in the monitoring and management of hypertension in England. The COVID-19 pandemic had a major impact on primary care management of long-term conditions such as hypertension. This study investigated the possible disproportionate impact of the pandemic across patient groups. DESIGN Open cohort of people with diagnosed hypertension. SETTINGS North East London primary care practices from January 2019 to October 2022. PARTICIPANTS All 224 329 adults with hypertension registered in 193 primary care practices. OUTCOMES Monitoring and management of hypertension were assessed using two indicators: (i) blood pressure recorded within 1 year of the index date and (ii) blood pressure control to national clinical practice guidelines. RESULTS The proportion of patients with a contemporaneous blood pressure recording fell from a 91% pre-pandemic peak to 62% at the end of the pandemic lockdown and improved to 77% by the end of the study. This was paralleled by the proportion of individuals with controlled hypertension which fell from a 73% pre-pandemic peak to 50% at the end of the pandemic lockdown and improved to 60% by the end of the study. However, when excluding patients without a recent blood pressure recording, the proportions of patients with controlled hypertension increased to 81%, 80% and 78% respectively.Throughout the study, in comparison to the White ethnic group, the Black ethnic group was less likely to achieve adequate blood pressure control (ORs 0.81 (95% CI 0.78 to 0.85, p<0.001) to 0.87 (95% CI 0.84 to 0.91, p<0.001)). Conversely, the Asian ethnic group was more likely to have controlled blood pressure (ORs 1.09 (95% CI 1.05 to 1.14, p<0.001) to 1.28 (95% CI 1.23 to 1.32, p<0.001)). Men, younger individuals, more affluent individuals, individuals with unknown or unrecorded ethnicity or those untreated were also less likely to have blood pressure control to target throughout the study. CONCLUSION The COVID-19 pandemic had a greater impact on blood pressure recording than on blood pressure control. Inequities in blood pressure control persisted during the pandemic and remain outstanding.
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Affiliation(s)
- Stuart Christopher Gorthorn Rison
- Clinical Effectiveness Group, Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Integrated Care System, NHS North East London, London, UK
| | - Oliver C Redfern
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Rohini Mathur
- Clinical Effectiveness Group, Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Isabel Dostal
- Clinical Effectiveness Group, Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Chris Carvalho
- Clinical Effectiveness Group, Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Integrated Care System, NHS North East London, London, UK
| | - Zahra Raisi-Estabragh
- Saint Bartholomew's Hospital Barts Heart Centre, London, UK
- Queen Mary University of London William Harvey Research Institute, London, UK
| | - John Robson
- Clinical Effectiveness Group, Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Hearld LR, Rathert C. The crisis of primary care and the case for more primary care management research. Health Care Manage Rev 2024; 49:159-160. [PMID: 38781080 DOI: 10.1097/hmr.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
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Houben F, den Heijer CDJ, Dukers-Muijrers NHTM, de Bont EGPM, Volbeda HT, Hoebe CJPA. Infection prevention and control in Dutch general practices before and during the COVID-19 pandemic and its implications for pandemic preparedness and seasonal respiratory epidemics: a qualitative study on lessons learned. BMC PRIMARY CARE 2024; 25:222. [PMID: 38902628 PMCID: PMC11191277 DOI: 10.1186/s12875-024-02451-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND The COVID-19 pandemic has prompted a re-evaluation of infection prevention and control (IPC) in general practices, highlighting the need for comprehensive IPC implementation. This study aimed to evaluate healthcare workers' (HCWs) experiences and perspectives regarding IPC in general practices before and during the COVID-19 pandemic, and its implications for post-pandemic IPC implementation. METHODS This qualitative study involved semi-structured, in-depth interviews during two time periods: (1) prior to the COVID-19 pandemic (July 2019-February 2020), involving 14 general practitioners (GPs) and medical assistants; and (2) during the COVID-19 pandemic (July 2022-February 2023), including 22 GPs and medical assistants. Data analysis included thematic analysis that addressed multiple system levels. RESULTS Findings indicated a shift towards comprehensive IPC implementation and organisation during the pandemic compared to the pre-pandemic period. Since the Omicron variant, some general practices maintained a broad set of IPC measures, while others released most measures. HCWs' future expectations on post-pandemic IPC implementation varied: some anticipated reduced implementation due to the desire to return to the pre-pandemic standard, while others expected IPC to be structurally scaled up during seasonal respiratory epidemics. Main contextual challenges included patient cooperation, staff shortages (due to infection), shortages of IPC materials/equipment, and frequently changing and ambiguous guidelines. Key lessons learned were enhanced preparedness (e.g., personal protective equipment supply), and a new perspective on care organisation (e.g., digital care). Main recommendations reported by HCWs were to strengthen regional collaboration within primary care, and between primary care, public health, and secondary care. CONCLUSION HCWs' experiences, perspectives and recommendations provide insights to enhance preparedness for future epidemics and pandemics, and sustain IPC in general practices. For IPC improvement strategies, adopting an integrated system-based approach that encompasses actions across multiple levels and engages multiple stakeholders is recommended.
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Affiliation(s)
- Famke Houben
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands.
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health MOSA, South Limburg Public Health Service, P.O. Box 33, Heerlen, 6400 AA, The Netherlands.
| | - Casper D J den Heijer
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health MOSA, South Limburg Public Health Service, P.O. Box 33, Heerlen, 6400 AA, The Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), P.O. Box 5800, Maastricht, 6202 AZ, The Netherlands
| | - Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health MOSA, South Limburg Public Health Service, P.O. Box 33, Heerlen, 6400 AA, The Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Eefje G P M de Bont
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Hanneke T Volbeda
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health MOSA, South Limburg Public Health Service, P.O. Box 33, Heerlen, 6400 AA, The Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Christian J P A Hoebe
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health MOSA, South Limburg Public Health Service, P.O. Box 33, Heerlen, 6400 AA, The Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), P.O. Box 5800, Maastricht, 6202 AZ, The Netherlands
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Abd Malek K, Ariffin F, Taher SW, Abd Aziz NA, Chew BH, Wong PF, Shariff Ghazali S, Abdullah A, Abdul Samad A, Sufian ZA, Han YW, Lai WJ, Selvaraj CS. Knowledge as a Predictor for Preparedness in Managing COVID-19 Among General Practitioners in Malaysia. Cureus 2024; 16:e63147. [PMID: 39055414 PMCID: PMC11272386 DOI: 10.7759/cureus.63147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction The COVID-19 pandemic has changed the working environment for general practitioners (GPs). GPs had to adapt quickly when care mitigation for mild COVID-19 in the community began. We assessed Malaysian GPs' knowledge and preparedness to manage COVID-19. Method A cross-sectional online survey was conducted between May and October 2022 among the GPs. Emails were sent to GPs affiliated with the main GP organizations in Malaysia, such as the Academy of Family Physicians of Malaysia (AFPM). Additionally, participation was sought through social media groups, including the Association of Malaysian Islamic Doctors, the Federation of Private Medical Practitioners' Associations Malaysia, and the Primary Care Network. Data was collected using a self-administered questionnaire on items related to knowledge and preparedness to manage COVID-19. The content was validated by six experts. Multiple logistic regression was used to determine the predictors for preparedness. Results A total of 178 GPs participated in this study. The mean age of the GPs was 41.8 (SD 12.37) years, 54.5% were males, 47.8% had a postgraduate qualification, and 68% had up to 10 years of general practice experience. Their practices are commonly solo (55.1%), located within an urban area (56.2%) and 47.2% operate 7 days a week. A majority of GPs (n = 124, 69.7%) had a good level of knowledge of COVID-19. In contrast, about a third (n = 60, 33.7%) had a good level of preparedness to manage COVID-19. GPs with a good level of knowledge of COVID-19 had 1.96 times the odds of having a good level of preparedness as compared to GPs with lower knowledge (OR = 2.11 (95% CI: 1.06, 4.18, p = 0.03)). Conclusion A good level of knowledge is a predictor for preparedness to manage COVID-19. Relevant and targeted measures to enhance knowledge for better preparedness among the GPs to respond to future pandemics are needed.
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Affiliation(s)
- Khasnur Abd Malek
- Primary Care Medicine Department, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Shah Alam, MYS
| | - Farnaza Ariffin
- Primary Care Medicine Department, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Shah Alam, MYS
| | - Sri Wahyu Taher
- Family Medicine, Klinik Kesihatan Simpang Kuala, Ministry of Health Malaysia, Alor Setar, MYS
| | - Noor Azah Abd Aziz
- Department of Family Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Boon-How Chew
- Family Medicine, Faculty of Medicine and Health Sciences, Family Medicine Specialists Clinic, Universiti Putra Malaysia, Serdang, MYS
- Family Medicine, Hospital Sultan Abdul Aziz Shah (HSAAS) Teaching Hospital, Family Medicine Specialists Clinic, Serdang, MYS
| | - Ping Foo Wong
- Family Medicine, Klinik Kesihatan Cheras Baru, Ministry of Health Malaysia, Kuala Lumpur, MYS
| | - Sazlina Shariff Ghazali
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
| | - Adina Abdullah
- Department of Primary Care, University of Malaya Medical Center, University of Malaya, Petaling Jaya, MYS
| | - Azah Abdul Samad
- Family Medicine, Shah Alam Health Clinic, Ministry of Health Malaysia, Selangor, MYS
| | - Ziti Akthar Sufian
- Family Medicine, Klinik Kesihatan Seri Kembangan, Ministry of Health Malaysia, Selangor, MYS
| | | | - Wei Jie Lai
- Family Medicine, Drs. Tong, Leow, Chiam & Partners, Kuala Lumpur, MYS
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Hewitt SL, Mills JE, Hoare KJ, Sheridan NF. The process of nurses' role negotiation in general practice: A grounded theory study. J Adv Nurs 2024; 80:1914-1926. [PMID: 37929935 DOI: 10.1111/jan.15938] [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: 02/19/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
AIM To explain the process by which nurses' roles are negotiated in general practice. BACKGROUND Primary care nurses do important work within a social model of health to meet the needs of the populations they serve. Latterly, in the face of increased demand and workforce shortages, they are also taking on more medical responsibilities through task-shifting. Despite the increased complexity of their professional role, little is known about the processes by which it is negotiated. DESIGN Constructivist grounded theory. METHODS Semi-structured interviews were conducted with 22 participants from 17 New Zealand general practices between December 2020 and January 2022. Due to COVID-19, 11 interviews were via Zoom™. Concurrent data generation and analysis, using the constant comparative method and common grounded theory methods, identified the participants' main concern and led to the construction of a substantive explanatory theory around a core category. RESULTS The substantive explanatory theory of creating place proposes that the negotiation of nurse roles within New Zealand general practice is a three-stage process involving occupying space, positioning to do differently and leveraging opportunity. Nurses and others act and interact in these stages, in accordance with their conceptualizations of need-responsive nursing practice, towards the outcome defining place. Defining place conceptualizes an accommodation between the values beliefs and expectations of individuals and pre-existing organizational norms, in which individual and group-normative concepts of need-responsive nursing practice are themselves developed. CONCLUSION The theory of creating place provides new insights into the process of nurses' role negotiation in general practice. Findings support strategies to enable nurses, employers and health system managers to better negotiate professional roles to meet the needs of the populations they serve, while making optimum use of nursing skills and competencies. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Findings can inform nurses to better negotiate the complexities of the primary care environment, balancing systemic exigencies with the health needs of populations. IMPACT What Problem Did the Study Address? In the face of health inequity, general practice nurses in New Zealand, as elsewhere, are key to meeting complex primary health needs. There is an evidence gap regarding the processes by which nurses' roles are negotiated within provider organizations. A deeper understanding of such processes may enable better use of nursing skills to address unmet health need. What Were the Main Findings? Nurses' roles in New Zealand general practice are determined through goal-driven negotiation in accordance with individual concepts of need-responsive nursing practice. Individuals progress from occupying workspaces defined by the care-philosophies of others to defining workplaces that incorporate their own professional beliefs, values and expectations. Negotiation is conditional upon access to role models, scheduled dialogue with mentors and decision-makers, and support for safe practice. Strong clinical and organizational governance and individuals' own positive personal self-efficacy are enablers of effective negotiation. Where and on Whom Will the Research Have Impact? The theory of Creating Space can inform organizational and individual efforts to advance the roles of general practice nurses to meet the health needs of their communities. General practice organizations can provide safe, supported environments for effective negotiation; primary care leaders can promote strong governance and develop individuals' sense of self-efficacy by involving them in key decisions. Nurses themselves can use the theory as a framework to support critical reflection on how to engage in active negotiation of their professional roles. REPORTING METHOD The authors adhered to relevant EQUATOR guidelines using the COREQ reporting method. PATIENT OR PUBLIC CONTRIBUTION Researchers and participants currently working in general practice were involved in the development of this study. By the process of theoretical sampling and constant comparison, participants' comments helped to shape the study design. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: An understanding of the processes by which health professionals negotiate their roles is important to support them to meet the challenges of increased complexity across all health sectors globally.
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Affiliation(s)
- Sarah Louise Hewitt
- School of Nursing, College of Health, Massey University, Albany, Auckland, New Zealand
| | - Jane Elizabeth Mills
- Office of La Trobe Rural Health, La Trobe University, Bendigo, Victoria, Australia
| | - Karen Jean Hoare
- School of Nursing, College of Health, Massey University, Albany, Auckland, New Zealand
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Ribeiro S, Takahashi EM, de Souza KL, Yamamoto TT, Leite RR, Fernandes H, Okuno MFP, Bertolozzi MR, de Figueiredo TMRM, Gonzales RIC, Hino P. Primary Health Care and Tuberculosis Detection during the COVID-19 Pandemic: Crucial Actions for Intensifying Efforts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:540. [PMID: 38791749 PMCID: PMC11121364 DOI: 10.3390/ijerph21050540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Tuberculosis has been considered a global emergency since 1993, and controlling it has become even more challenging since 2020 due to the health and social crisis resulting from the COVID-19 pandemic. This study aimed to identify the impact of the COVID-19 pandemic on tuberculosis case detection activities within primary health Care in the largest city in Brazil. METHODS This is a cross-sectional and analytical study on the provision of tuberculosis detection actions in primary healthcare units during the pandemic period. A descriptive analysis was performed for characterization, and Generalized Mixed Models were used for evaluating associations, with a Bonferroni post hoc test applied. RESULTS The study sample comprised 80 health units in the municipality. There was a moderate alteration level in the provision of consultations for individuals with signs and symptoms of tuberculosis in 2020 (13.8%) and in 2021 (15.1%). Statistical significance (p < 0.05) was found between the pandemic period and detection actions, with a lower alteration level in 2022. CONCLUSIONS Tuberculosis detection activities underwent changes due to the COVID-19 pandemic, mainly in 2020, which was associated with alterations in consultation and case notification provision.
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Affiliation(s)
- Stephanie Ribeiro
- Department of Collective Health, Paulista School of Nursing, Federal University of São Paulo, São Paulo 04024-002, São Paulo, Brazil; (E.M.T.); (H.F.); (M.F.P.O.); (P.H.)
| | - Erika Mayumi Takahashi
- Department of Collective Health, Paulista School of Nursing, Federal University of São Paulo, São Paulo 04024-002, São Paulo, Brazil; (E.M.T.); (H.F.); (M.F.P.O.); (P.H.)
| | - Katia Lacerda de Souza
- Department of Collective Health, Paulista School of Nursing, Federal University of São Paulo, São Paulo 04024-002, São Paulo, Brazil; (E.M.T.); (H.F.); (M.F.P.O.); (P.H.)
| | - Thais Tiemi Yamamoto
- Municipal Health Secretariat of São Paulo, Health Surveillance Coordination, São Paulo 01223-010, São Paulo, Brazil (R.R.L.)
| | - Raquel Russo Leite
- Municipal Health Secretariat of São Paulo, Health Surveillance Coordination, São Paulo 01223-010, São Paulo, Brazil (R.R.L.)
| | - Hugo Fernandes
- Department of Collective Health, Paulista School of Nursing, Federal University of São Paulo, São Paulo 04024-002, São Paulo, Brazil; (E.M.T.); (H.F.); (M.F.P.O.); (P.H.)
| | - Meiry Fernanda Pinto Okuno
- Department of Collective Health, Paulista School of Nursing, Federal University of São Paulo, São Paulo 04024-002, São Paulo, Brazil; (E.M.T.); (H.F.); (M.F.P.O.); (P.H.)
| | - Maria Rita Bertolozzi
- Department of Public Health Nursing, School of Nursing, University of São Paulo, São Paulo 05403-000, São Paulo, Brazil;
| | | | | | - Paula Hino
- Department of Collective Health, Paulista School of Nursing, Federal University of São Paulo, São Paulo 04024-002, São Paulo, Brazil; (E.M.T.); (H.F.); (M.F.P.O.); (P.H.)
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11
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Kirkove D, Willems S, Van Poel E, Dardenne N, Donneau AF, Perrin E, Ponsar C, Mallen C, Stylianou N, Collins C, Gagnayre R, Pétré B. Characteristics of primary care practices associated with patient education during COVID-19: results of the cross-sectional PRICOV-19 study in 38 countries. BMC PRIMARY CARE 2024; 24:285. [PMID: 38637765 PMCID: PMC11027213 DOI: 10.1186/s12875-024-02348-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND In response to the COVID-19 pandemic, the World Health Organization established a number of key recommendations such as educational activities especially within primary care practices (PCPs) which are a key component of this strategy. This paper aims to examine the educational activities of PCPs during COVID-19 pandemic and to identify the factors associated with these practices across 38 countries. METHODS A "Patient Education (PE)" score was created based on responses to six items from the self-reported questionnaire among PCPs (n = 3638) compiled by the PRICOV-19 study. Statistical analyses were performed on 3638 cases, with PCPs with missing PE score values were excluded. RESULTS The PE score features a mean of 2.55 (SD = 0.68) and a median of 2.50 (2.16 - 3.00), with a maximum of 4.00, and varies quite widely between countries. Among all PCPs characteristics, these factors significantly increase the PE score: the payment system type (with a capitation payment system or another system compared to the fee for service), the perception of average PCP with patients with chronic conditions and the perception of adequate governmental support. CONCLUSION The model presented in this article is still incomplete and requires further investigation to identify other configuration elements favorable to educational activities. However, the results already highlight certain levers that will enable the development of this educational approach appropriate to primary care.
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Affiliation(s)
- Delphine Kirkove
- Department of Public Health Sciences, University of Liege, B23 / Avenue Hippocrate, n°13, 4000, Liège, Belgium.
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Nadia Dardenne
- Department of Public Health Sciences, University of Liege, B23 / Avenue Hippocrate, n°13, 4000, Liège, Belgium
- Biostatistics and Research Method Center, University of Liege, Liege, Belgium
| | - Anne-Françoise Donneau
- Department of Public Health Sciences, University of Liege, B23 / Avenue Hippocrate, n°13, 4000, Liège, Belgium
- Biostatistics and Research Method Center, University of Liege, Liege, Belgium
| | - Elodie Perrin
- Department of Public Health Sciences, University of Liege, B23 / Avenue Hippocrate, n°13, 4000, Liège, Belgium
| | - Cécile Ponsar
- Institute of Health and Society, Louvain University, Louvain, Belgium
| | | | - Neophytos Stylianou
- International Institute for Compassionate Care, Nicosia, Cyprus
- NS Intelligence Solutions Ltd, Nicosia, Cyprus
| | - Claire Collins
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Research Centre, Irish College of General Practitioners, Dublin, D02XR68, Ireland
| | - Rémi Gagnayre
- Education and Health Practices Laboratory (LEPS), (UR 3412), UFR SMBH, Sorbonne Paris-Nord University, Bobigny, France
| | - Benoit Pétré
- Department of Public Health Sciences, University of Liege, B23 / Avenue Hippocrate, n°13, 4000, Liège, Belgium
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12
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Nolde JM, Streets F, Meyer D, Chen WS, Wei J, Wickramasinghe N, Hannebery P, Lambert GW, Schlaich MP. Trends in blood pressure changes and hypertension prevalence in Australian adults before and during the COVID-19 pandemic. J Clin Hypertens (Greenwich) 2024; 26:145-154. [PMID: 38224191 PMCID: PMC10857471 DOI: 10.1111/jch.14761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/10/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024]
Abstract
Efforts to limit the impact of the coronavirus disease (COVID-19) pandemic led to the implementation of public health measures and reallocation of health resources. To investigate trends in blood pressure (BP), hypertension and BMI in the Australian population during the COVID-19 pandemic, data from publicly accessible health stations were analyzed. Average BP and BMI measured by the SiSU Health Station network in Australia in over 1.6 million health screenings were compared between the years 2018 and 2021. Additionally, paired trajectories for BP and BMI development before and during the COVID-19 pandemic were calculated. Comparisons between pre-COVID years and post-COVID years of 2018 versus 2020, 2019 versus 2020, 2018 versus 2021, and 2019 versus 2021 showed increases in average adjusted systolic BP of 2.0, 1.7, 2.6, and 2.3 mmHg, respectively. Paired analysis of longitudinal data showed an overall increase in the trajectory of systolic BP of 3.2 mmHg between pre- and post-COVID years. The prevalence of hypertension in users of the health stations increased by approximately 25% in the years 2020-2021. Similar trends were seen for BMI. Data from public Australian health stations indicated a strong trend toward higher BP during the COVID-19 pandemic. At the population level, BP increments have been shown to markedly increase cardiovascular disease risk. Anti-pandemic measures need to be carefully evaluated in terms of secondary public health effects and health support systems extended to effectively target cardiovascular risk.
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Affiliation(s)
- Janis M. Nolde
- Dobney Hypertension CentreMedical School ‐ Royal Perth Hospital Unit / Medical Research FoundationUniversity of Western AustraliaPerthAustralia
| | | | - Denny Meyer
- Department of Health Science and BiostatisticsSchool of Health SciencesSwinburne University of TechnologyMelbourneAustralia
| | - Won Sun Chen
- Department of Health Science and BiostatisticsSchool of Health SciencesSwinburne University of TechnologyMelbourneAustralia
| | | | - Nilmini Wickramasinghe
- Iverson Health Innovation Research Institute and School of Health SciencesSwinburne University of TechnologyMelbourneAustralia
| | | | - Gavin W. Lambert
- Iverson Health Innovation Research Institute and School of Health SciencesSwinburne University of TechnologyMelbourneAustralia
| | - Markus P. Schlaich
- Dobney Hypertension CentreMedical School ‐ Royal Perth Hospital Unit / Medical Research FoundationUniversity of Western AustraliaPerthAustralia
- Department of Cardiology and NephrologyRoyal Perth HospitalPerthAustralia
- Neurovascular Hypertension & Kidney Disease LaboratoryBaker Heart and Diabetes InstituteMelbourneAustralia
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13
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Ahmedani BK, Yeh HH, Penfold RB, Simon GE, Miller-Matero LR, Akinyemi E, Fallone M, Patel S, Beebani G, Hooker SA, Owen-Smith A, Knowlton G, Levin A, Eke-Usim A, Rossom RC. Psychotherapy Disruption Before and After the Transition to Virtual Mental Health Care Induced by the COVID-19 Pandemic. Psychiatr Serv 2024; 75:108-114. [PMID: 37817579 DOI: 10.1176/appi.ps.20230181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
OBJECTIVE This study aimed to examine population-level disruption in psychotherapy before and after the rapid shift to virtual mental health care induced by the onset of the COVID-19 pandemic in the United States. METHODS This retrospective study used electronic health record and insurance claims data from three U.S. health systems. The sample included 110,089 patients with mental health conditions who were members of the health systems' affiliated health plans and attended at least two psychotherapy visits from June 14, 2019, through December 15, 2020. Data were subdivided into two 9-month periods (before vs. after COVID-19 onset, defined in this study as March 14, 2020). Psychotherapy visits were measured via health records and categorized as in person or virtual. Disruption was defined as a gap of >45 days between visits. RESULTS Visits in the preonset period were almost exclusively in person (97%), whereas over half of visits in the postonset period were virtual (52%). Approximately 35% of psychotherapy visits were followed by a disruption in the preonset period, compared with 18% in the postonset period. Disruption continued to be less common (adjusted OR=0.45) during the postonset period after adjustment for visit, mental health, and sociodemographic factors. The magnitude of the difference in disruption between periods was homogeneous across sociodemographic characteristics but heterogeneous across psychiatric diagnoses. CONCLUSIONS This study found fewer population-level disruptions in psychotherapy receipt after rapid transition to virtual mental health care following COVID-19 onset. These data support the continued availability of virtual psychotherapy.
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Affiliation(s)
- Brian K Ahmedani
- Center for Health Policy and Health Services Research (Ahmedani, Yeh, Miller-Matero), Behavioral Health Services (Ahmedani, Miller-Matero, Akinyemi, Fallone, Patel, Beebani), and Public Health Sciences (Levin), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Penfold, Simon); HealthPartners Institute, Minneapolis (Hooker, Knowlton, Rossom); Center for Research and Evaluation, Kaiser Permanente Georgia, and Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta (Owen-Smith); Authority Health, Detroit (Eke-Usim)
| | - Hsueh-Han Yeh
- Center for Health Policy and Health Services Research (Ahmedani, Yeh, Miller-Matero), Behavioral Health Services (Ahmedani, Miller-Matero, Akinyemi, Fallone, Patel, Beebani), and Public Health Sciences (Levin), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Penfold, Simon); HealthPartners Institute, Minneapolis (Hooker, Knowlton, Rossom); Center for Research and Evaluation, Kaiser Permanente Georgia, and Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta (Owen-Smith); Authority Health, Detroit (Eke-Usim)
| | - Robert B Penfold
- Center for Health Policy and Health Services Research (Ahmedani, Yeh, Miller-Matero), Behavioral Health Services (Ahmedani, Miller-Matero, Akinyemi, Fallone, Patel, Beebani), and Public Health Sciences (Levin), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Penfold, Simon); HealthPartners Institute, Minneapolis (Hooker, Knowlton, Rossom); Center for Research and Evaluation, Kaiser Permanente Georgia, and Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta (Owen-Smith); Authority Health, Detroit (Eke-Usim)
| | - Gregory E Simon
- Center for Health Policy and Health Services Research (Ahmedani, Yeh, Miller-Matero), Behavioral Health Services (Ahmedani, Miller-Matero, Akinyemi, Fallone, Patel, Beebani), and Public Health Sciences (Levin), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Penfold, Simon); HealthPartners Institute, Minneapolis (Hooker, Knowlton, Rossom); Center for Research and Evaluation, Kaiser Permanente Georgia, and Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta (Owen-Smith); Authority Health, Detroit (Eke-Usim)
| | - Lisa R Miller-Matero
- Center for Health Policy and Health Services Research (Ahmedani, Yeh, Miller-Matero), Behavioral Health Services (Ahmedani, Miller-Matero, Akinyemi, Fallone, Patel, Beebani), and Public Health Sciences (Levin), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Penfold, Simon); HealthPartners Institute, Minneapolis (Hooker, Knowlton, Rossom); Center for Research and Evaluation, Kaiser Permanente Georgia, and Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta (Owen-Smith); Authority Health, Detroit (Eke-Usim)
| | - Esther Akinyemi
- Center for Health Policy and Health Services Research (Ahmedani, Yeh, Miller-Matero), Behavioral Health Services (Ahmedani, Miller-Matero, Akinyemi, Fallone, Patel, Beebani), and Public Health Sciences (Levin), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Penfold, Simon); HealthPartners Institute, Minneapolis (Hooker, Knowlton, Rossom); Center for Research and Evaluation, Kaiser Permanente Georgia, and Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta (Owen-Smith); Authority Health, Detroit (Eke-Usim)
| | - Marisa Fallone
- Center for Health Policy and Health Services Research (Ahmedani, Yeh, Miller-Matero), Behavioral Health Services (Ahmedani, Miller-Matero, Akinyemi, Fallone, Patel, Beebani), and Public Health Sciences (Levin), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Penfold, Simon); HealthPartners Institute, Minneapolis (Hooker, Knowlton, Rossom); Center for Research and Evaluation, Kaiser Permanente Georgia, and Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta (Owen-Smith); Authority Health, Detroit (Eke-Usim)
| | - Shivali Patel
- Center for Health Policy and Health Services Research (Ahmedani, Yeh, Miller-Matero), Behavioral Health Services (Ahmedani, Miller-Matero, Akinyemi, Fallone, Patel, Beebani), and Public Health Sciences (Levin), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Penfold, Simon); HealthPartners Institute, Minneapolis (Hooker, Knowlton, Rossom); Center for Research and Evaluation, Kaiser Permanente Georgia, and Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta (Owen-Smith); Authority Health, Detroit (Eke-Usim)
| | - Ganj Beebani
- Center for Health Policy and Health Services Research (Ahmedani, Yeh, Miller-Matero), Behavioral Health Services (Ahmedani, Miller-Matero, Akinyemi, Fallone, Patel, Beebani), and Public Health Sciences (Levin), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Penfold, Simon); HealthPartners Institute, Minneapolis (Hooker, Knowlton, Rossom); Center for Research and Evaluation, Kaiser Permanente Georgia, and Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta (Owen-Smith); Authority Health, Detroit (Eke-Usim)
| | - Stephanie A Hooker
- Center for Health Policy and Health Services Research (Ahmedani, Yeh, Miller-Matero), Behavioral Health Services (Ahmedani, Miller-Matero, Akinyemi, Fallone, Patel, Beebani), and Public Health Sciences (Levin), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Penfold, Simon); HealthPartners Institute, Minneapolis (Hooker, Knowlton, Rossom); Center for Research and Evaluation, Kaiser Permanente Georgia, and Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta (Owen-Smith); Authority Health, Detroit (Eke-Usim)
| | - Ashli Owen-Smith
- Center for Health Policy and Health Services Research (Ahmedani, Yeh, Miller-Matero), Behavioral Health Services (Ahmedani, Miller-Matero, Akinyemi, Fallone, Patel, Beebani), and Public Health Sciences (Levin), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Penfold, Simon); HealthPartners Institute, Minneapolis (Hooker, Knowlton, Rossom); Center for Research and Evaluation, Kaiser Permanente Georgia, and Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta (Owen-Smith); Authority Health, Detroit (Eke-Usim)
| | - Gregory Knowlton
- Center for Health Policy and Health Services Research (Ahmedani, Yeh, Miller-Matero), Behavioral Health Services (Ahmedani, Miller-Matero, Akinyemi, Fallone, Patel, Beebani), and Public Health Sciences (Levin), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Penfold, Simon); HealthPartners Institute, Minneapolis (Hooker, Knowlton, Rossom); Center for Research and Evaluation, Kaiser Permanente Georgia, and Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta (Owen-Smith); Authority Health, Detroit (Eke-Usim)
| | - Albert Levin
- Center for Health Policy and Health Services Research (Ahmedani, Yeh, Miller-Matero), Behavioral Health Services (Ahmedani, Miller-Matero, Akinyemi, Fallone, Patel, Beebani), and Public Health Sciences (Levin), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Penfold, Simon); HealthPartners Institute, Minneapolis (Hooker, Knowlton, Rossom); Center for Research and Evaluation, Kaiser Permanente Georgia, and Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta (Owen-Smith); Authority Health, Detroit (Eke-Usim)
| | - Angela Eke-Usim
- Center for Health Policy and Health Services Research (Ahmedani, Yeh, Miller-Matero), Behavioral Health Services (Ahmedani, Miller-Matero, Akinyemi, Fallone, Patel, Beebani), and Public Health Sciences (Levin), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Penfold, Simon); HealthPartners Institute, Minneapolis (Hooker, Knowlton, Rossom); Center for Research and Evaluation, Kaiser Permanente Georgia, and Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta (Owen-Smith); Authority Health, Detroit (Eke-Usim)
| | - Rebecca C Rossom
- Center for Health Policy and Health Services Research (Ahmedani, Yeh, Miller-Matero), Behavioral Health Services (Ahmedani, Miller-Matero, Akinyemi, Fallone, Patel, Beebani), and Public Health Sciences (Levin), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Penfold, Simon); HealthPartners Institute, Minneapolis (Hooker, Knowlton, Rossom); Center for Research and Evaluation, Kaiser Permanente Georgia, and Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta (Owen-Smith); Authority Health, Detroit (Eke-Usim)
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14
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Senthinathan A, Tu K, Stephenson E, O'Neill B, Lipscombe L, Ji C, Butt DA, Apajee J, Train A, Crampton N. A comparison between different patient groups for diabetes management during phases of the COVID-19 pandemic: a retrospective cohort study in Ontario, Canada. BMC PRIMARY CARE 2024; 25:43. [PMID: 38280984 PMCID: PMC10821561 DOI: 10.1186/s12875-024-02272-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/10/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND With the onset of the COVID-19 pandemic and the large uptake in virtual care in primary care in Canada, the care of patients with type 2 diabetes has been greatly affected. This includes decreased in-person visits, laboratory testing and in-person assessments such as blood pressure (BP). No studies have investigated if these changes persisted with pandemic progression, and it is unclear if shifts impacted patient groups uniformly. The purpose of this paper was to examine changes in diabetes care pre, early, and later pandemic across different patient groups. METHODS A repeated cross-sectional design with an open cohort was used to investigate diabetes care in adults with type 2 diabetes for a 6-month interval from March 14 to September 13 over three consecutive years: 2019 (pre-pandemic period), 2020 (early pandemic period), and 2021 (later pandemic period). Data for this study were abstracted from the University of Toronto Practice-Based Research Network (UTOPIAN) Data Safe Haven, a primary care electronic medical records database in Ontario, Canada. Changes in diabetes care, which included primary care total visits, in-person visits, hemoglobin A1c (HbA1c) testing, and BP measurements were evaluated across the phases of the pandemic. Difference in diabetes care across patient groups, including age, sex, income quintile, prior HbA1c levels, and prior BP levels, were assessed. RESULTS A total of 39,401 adults with type 2 diabetes were included in the study. Compared to the 6-month pre-pandemic period, having any in-person visits decreased significantly early pandemic (OR = 0.079 (0.076-0.082)), with a partial recovery later pandemic (OR = 0.162 (95% CI: 0.157-0.169). Compared to the pre-pandemic period, there was a significant decrease early pandemic for total visits (OR = 0.486 (95% CI: 0.470-0.503)), HbA1c testing (OR = 0.401 (95% CI: 0.389-0.413)), and BP measurement (OR = 0.121 (95% CI: 0.116-0.125)), with partial recovery later pandemic. CONCLUSIONS All measures of diabetes care were substantially decreased early pandemic, with a partial recovery later pandemic across all patient groups. With the increase in virtual care due to the COVID-19 pandemic, diabetes care has been negatively impacted over 1-year after pandemic onset.
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Affiliation(s)
- A Senthinathan
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
| | - K Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
| | - E Stephenson
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - B O'Neill
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
- MAP Centre for Urban Health Solutions, LiKa Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - L Lipscombe
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - C Ji
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - D A Butt
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Scarborough Health Network, Toronto, ON, Canada
| | - J Apajee
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - A Train
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - N Crampton
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
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15
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Morgan CL, Durand A, McCormack T, Hughes E, Berni TR, Lahoz R. Risk of major adverse cardiovascular events associated with elevated low-density lipoprotein cholesterol in a population with atherosclerotic cardiovascular disease with and without type 2 diabetes: a UK database analysis using the Clinical Practice Research Datalink. BMJ Open 2023; 13:e064541. [PMID: 38030254 PMCID: PMC10689406 DOI: 10.1136/bmjopen-2022-064541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES To estimate the 12-month probabilities of major adverse cardiovascular events (MACE) and non-cardiovascular death in patients with atherosclerotic cardiovascular disease (ASCVD) and elevated low-density lipoprotein cholesterol (LDL-C). DESIGN A retrospective database analysis. SETTING UK primary care. PARTICIPANTS Patients were selected from the Clinical Practice Research Datalink (Aurum) linked to Hospital Episode Statistics inpatient and Office of National Statistics mortality datasets. Patients with an ASCVD diagnosis between 01 January 2010 and 31 May 2018 and LDL-C ≥2.6 mmol/L were selected. PRIMARY OUTCOMES Primary outcomes were 12-month risk of (1) MACE (composite of revascularisation, unstable angina, non-fatal myocardial infarction, non-fatal stroke and cardiovascular death) and (2) non-cardiovascular mortality. Kaplan-Meier survival analysis estimated the probability of each outcome. A Cox proportional hazards model explored covariates associated with MACE. RESULTS Of 102 245 study patients, 16 501 (16.1%) had a diagnosis of type 2 diabetes (T2DM). 65.5% of those with and 49.9% of those without T2DM had a lipid-lowering therapy (LLT) 6 months prior to index diagnosis. Twelve-month probability of MACE was 7.9% for non-T2DM and 11.8% for T2DM. LDL-C was significantly associated with risk of MACE (HR=1.19 (95% CI 1.16 to 1.22) per 1 mmol/L). History of acute coronary syndrome, other coronary heart disease, stroke and T2DM significantly increased the risk of MACE. Ezetimibe (0.88 (95% CI 0.79 to 0.99)) and low-intensity statins (0.88 (95% CI 0.79 to 0.97)) were associated with reduced 12-month MACE risk.and low-intensity statins 0.88 (95% CI 0.79 to 0.97) CONCLUSION: We confirmed the association between elevated LDL-C and MACE. Many patients with ASCVD and elevated LDL-C were untreated with LLT. With the increasing demands on general practitioners, initiatives aimed at improving identification and treatment of at-risk patients within primary care should be considered.
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Affiliation(s)
| | | | - Terry McCormack
- Institute of Clinical and Applied Health Research, Hull York Medical School, Hull, UK
| | - Elizabeth Hughes
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, Birmingham, UK
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Moser A, Korstjens I. Series: Practical guidance to qualitative research. Part 7: Qualitative evidence synthesis for emerging themes in primary care research: Scoping review, meta-ethnography and rapid realist review. Eur J Gen Pract 2023; 29:2274467. [PMID: 37902265 PMCID: PMC10990260 DOI: 10.1080/13814788.2023.2274467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/09/2023] [Indexed: 10/31/2023] Open
Abstract
This article, the seventh in a series aiming to provide practical guidance for qualitative research in primary care, introduces qualitative synthesis research for addressing health themes in primary care research. Qualitative synthesis combines rigorous processes and authorial judgement to present the collective meaning of research outputs; the findings of qualitative studies - and sometimes mixed-methods and quantitative research - are pooled. We describe three exemplary designs: the scoping review, the meta-ethnography and the rapid realist review. Scoping reviews aim to provide an overview of the evidence/knowledge or to answer questions regarding the nature and diversity of the evidence/knowledge available. Meta-ethnographies intend to systematically compare data from primary qualitative studies to identify and develop new overarching concepts, theories, and models. Rapid realist reviews aim to provide a knowledge synthesis by looking at complex questions while responding to time-sensitive and emerging issues. It addresses the question, 'what works, for whom, in what circumstances, and how?'We discuss these three designs' context, what, why, when and how. We provide examples of published studies and sources for further reading, including manuals and guidelines for conducting and reporting these studies. Finally, we discuss attention points for the research team concerning the involvement of necessary experts and stakeholders and choices to be made during the research process.
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Affiliation(s)
- Albine Moser
- Faculty of Health Care, Research Centre Autonomy and Participation of Chronically Ill People, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Department of Family Medicine and Department of Health Service Research, Maastricht University, Maastricht, The Netherlands
| | - Irene Korstjens
- Faculty of Health Care, Research Centre for Midwifery Science, Zuyd University of Applied Sciences, Maastricht, The Netherlands
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17
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Celino SDDM, de Albuquerque Filho NJB, Gomes MDNC, Costa GMC, de Mendonça AEO. Evaluation of primary health care by users during the COVID-19 pandemic: A cross-sectional study. PLoS One 2023; 18:e0292039. [PMID: 37738255 PMCID: PMC10516436 DOI: 10.1371/journal.pone.0292039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE To evaluate the primary health care (PHC) attributes and associated factors during the COVID-19 pandemic using the perspective of users. METHODS This cross-sectional, quantitative study included 422 PHC users from 96 Family Health Teams in a city in Brazil. The assessment used the Primary Care Assessment Tool (PCATool) and a structured questionnaire on the sociodemographic and epidemiological characteristics of users and basic health units (BHU). The Person's chi-square test was used to analyze the association between high overall scores in PCATool and characteristics of users and BHU. Crude and adjusted prevalence ratios (PR) with a 95% confidence interval were also calculated. Poisson regression and Rao Scott's Chi-square test were used to estimate crude PR. RESULTS Most users were aged 30 to 39 years (26.3%), women (75.4%), registered at the BHU for over ten years (59.5%), and had incomplete secondary education (30.6%). The mean of PHC essential attributes and overall scores were low (6.10 ± 0.81 and 5.78 ± 0.77, respectively). "First-contact care-use" received the highest score (9.22 ± 1.62), while "first-contact care-accessibility" received the lowest (2.82 ± 0.90). High overall scores were associated with an average employment time of professionals (doctors and nurses) at the BHU (PR = 1.31; 95% CI 1.17-1.48; p < 0.001) and lower educational level of users (PR = 1.71; 95% CI 1.54-1.90; p < 0.001. CONCLUSION "First-contact care-use" was the best evaluated, while "first-contact care-accessibility" was the worst. High scores were associated with a lower educational level of users and BHU with more experienced professionals.
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18
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Hickey MT, Stillo M, Marquez C. An interprofessional clinical experience to address social determinants of health. J Am Assoc Nurse Pract 2023; 35:559-567. [PMID: 37071571 DOI: 10.1097/jxx.0000000000000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/13/2023] [Indexed: 04/19/2023]
Abstract
ABSTRACT The importance of effective interprofessional communication and collaboration as a strategy to improve patient outcomes has been documented in the literature. Efforts to integrate interprofessional education have been difficult to actualize due to myriad factors in academic and clinical settings. The COVID public health emergency presented an unexpected opportunity to address the needs of an underserved community through an interprofessional clinical experience between medical and APRN students. A screening tool and resource-driven algorithm were developed and launched by students in the college of medicine, for the patients of a university hospital clinic. This initiative helped meet the needs of the community, with the value-added benefit of an interprofessional clinical experience. Using a train-the-trainer model, students were oriented to the project and an online platform for real-time collaboration. Results of this initiative were positive. Approximately 100 medical and APRN students participated and contacted 1,489 patients in the community. Medical and social needs were addressed for 681 patients, and urgent social needs were addressed for 30 people. Students gained valuable clinical experience and had opportunities to identify and address social determinants of health while collaborating with medical student counterparts.
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Affiliation(s)
| | | | - Crystal Marquez
- Department of Family Medicine, SUNY-Downstate Medical Center
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19
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Spiess ST, Gardner E, Turner C, Galt A, Fortenberry K, Ho T, Knox J, Ose D. We Cannot Put This Genie Back in the Bottle: Qualitative Interview Study Among Family Medicine Providers About Their Experiences With Virtual Visits During the COVID-19 Pandemic. J Med Internet Res 2023; 25:e43877. [PMID: 37651162 PMCID: PMC10502598 DOI: 10.2196/43877] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND When a genie is freed from its bottle, things cannot be restored to the way they were before. At the beginning of the global COVID-19 pandemic, health care systems adjusted how they delivered care overnight. Primary care practices switched from seeing patients in person to virtual care applications, including video and phone visits, e-visits, e-consults, and messaging with clinicians. Prior to the pandemic, these applications were not as widely used, but discussions around their advantages and disadvantages in some settings were being explored. Emergency regulatory changes spurred by the pandemic freed this virtual care "genie" from its bottle. Wide-scale adoption of virtual care in family medicine has much potential, as primary care services are often a patient's first point of contact with the health care system. OBJECTIVE This study aims to analyze family medicine providers' experiences using virtual visits during the pandemic, perceived outcomes of the shift to virtual visits, and discusses its implications for the future of family medicine. METHODS This qualitative study took place at 3 academic primary care clinics between June and December 2020. Data were collected through one-on-one Zoom (version 5.2.1) interviews with family medicine clinical faculty who experienced the rapid transition of in-person visits to mostly "virtual" visits. The interviews were recorded, deidentified, and transcribed. We adopted a constructivist approach to qualitative content analysis to evaluate the results. RESULTS In total, 25 participants were eligible, and 20 individuals participated in this study (80% participation rate). The mean age was 43.4 years, and 85% (17/20) of the participants were female. We identified 3 main themes: the care process, patient engagement, and team-based care. CONCLUSIONS This study highlights the transition from in-person to virtual visits during the pandemic from the perspective of family medicine providers. Generally, family medicine providers' perceptions of the shift to virtual visits were positive, especially regarding team-based care. Challenges involved virtual inhibition, particularly for providers. Providers described ways they integrated virtual care with aspects of in-person care, creating a hybrid environment. The genie is out of the bottle-things will not be the same-but family medicine now has the opportunity to evolve.
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Affiliation(s)
- Saskia T Spiess
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Elena Gardner
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Cindy Turner
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Annie Galt
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Katherine Fortenberry
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Tiffany Ho
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Jordan Knox
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Dominik Ose
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
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20
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Jonnagaddala J, Hoang U, Wensaas KA, Tu K, Ortigoza A, Silva-Valencia J, Cuba-Fuentes MS, Godinho MA, de Lusignan S, Liaw ST. Integrated Management Systems (IMS) to Support and Sustain Quality One Health Services: International Lessons from the COVID-19 Pandemic by the IMIA Primary Care Working Group. Yearb Med Inform 2023; 32:55-64. [PMID: 37414035 PMCID: PMC10751124 DOI: 10.1055/s-0043-1768725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVES One Health considers human, animal and environment health as a continuum. The COVID-19 pandemic started with the leap of a virus from animals to humans. Integrated management systems (IMS) should provide a coherent management framework, to meet reporting requirements and support care delivery. We report IMS deployment during, and retention post the COVID-19 pandemic, and exemplar One Health use cases. METHODS Six volunteer members of the International Medical Association's (IMIA) Primary Care Working Group provided data about any IMS and One Health use to support the COVID-19 pandemic initiatives. We explored how IMS were: (1) Integrated with organisational strategy; (2) Utilised standardised processes, and (3) Met reporting requirements, including public health. Selected contributors provided Unified Modelling Language (UML) use case diagram for a One Health exemplar. RESULTS There was weak evidence of synergy between IMS and health system strategy to the COVID-19 pandemic. However, there were rapid pragmatic responses to COVID-19, not citing IMS. All health systems implemented IMS to link COVID test results, vaccine uptake and outcomes, particularly mortality and to provide patients access to test results and vaccination certification. Neither proportion of gross domestic product alone, nor vaccine uptake determined outcome. One Health exemplars demonstrated that animal, human and environmental specialists could collaborate. CONCLUSIONS IMS use improved the pandemic response. However, IMS use was pragmatic rather than utilising an international standard, with some of their benefits lost post-pandemic. Health systems should incorporate IMS that enables One Health approaches as part of their post COVID-19 pandemic preparedness.
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Affiliation(s)
| | - Uy Hoang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | | | - Karen Tu
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada
| | - Angela Ortigoza
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada
| | - Javier Silva-Valencia
- Center for Research in Primary Health Care (CINAPS), School of Medicine, Universidad Peruana Cayetano Heredia, Peru
| | - María Sofía Cuba-Fuentes
- Center for Research in Primary Health Care (CINAPS), School of Medicine, Universidad Peruana Cayetano Heredia, Peru
| | | | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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21
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Arnold-Reed DE, Bulsara CE, Gilkes L. Disruption caused by the COVID-19 pandemic response from a Western Australian metropolitan general practice perspective: a qualitative descriptive study. Aust J Prim Health 2023; 29:385-394. [PMID: 36683177 DOI: 10.1071/py22136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/29/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND In 2020 and 2021, Western Australia (WA) was an early adopter of the 'COVID zero' policy, eliminating community transmission and pursuing vaccine roll out to enable a 'soft landing' once coronavirus disease 2019 (COVID-19) infiltrated the community in 2022. Optimisation and augmentation of general practice services were at the forefront of policies. This study explores metropolitan general practice responses to the resulting disruption caused. METHODS Qualitative descriptive methodology, purposive sampling and template analysis were used. Semi-structured interviews were undertaken from March to June 2021 with teams from six general practices in metropolitan WA; six general practitioners, four practice nurses and three practice managers. RESULTS Staff at all levels responded rapidly amid uncertainty and workload challenges with marked personal toll (anxiety and fear of exposure to risks, frustrations of patients and balancing work and family life). Self-reliance, teamwork and communication strategies built on inclusivity, autonomy and support were important. Responding to changes in general patient behaviour was to the fore. Increasing use of telehealth (telephone and video) became important to meet patient needs. Lessons learned from what was implemented in early-stage lockdowns provided practices with preparedness for the future, and smoother transitions during subsequent lockdowns. CONCLUSION The study demonstrates the self-reliance, teamwork and adaptability of the general practice sector in responding to a sudden, unexpected major disruption, yet maintaining ongoing service provision for their patients. Although the COVID-19 landscape has now changed, the lessons learned and the planning that took place will help general practice in WA adapt to similar future situations readily.
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Affiliation(s)
- Diane E Arnold-Reed
- School of Medicine, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, WA 6959, Australia
| | - Caroline E Bulsara
- School of Nursing and Midwifery, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, WA 6959, Australia; and Institute for Health Research, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, WA 6959, Australia
| | - Lucy Gilkes
- School of Medicine, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, WA 6959, Australia
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22
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Staras SAS, Salloum RG, Osegueda E, Bylund CL, Chi X, Mohan V, Sage E, Huo T, Young A, Thompson LA. North-Central Florida Clinicians' Human Papillomavirus Vaccine Recommendation Priorities and Practices for 11- to 12-Year-Olds: A Discrete Choice Experiment. J Adolesc Health 2023; 73:172-180. [PMID: 37029049 DOI: 10.1016/j.jadohealth.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/20/2023] [Accepted: 02/01/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE Within the United States, human papillomavirus (HPV) vaccination rates remain low. We examined HPV vaccine recommendation practices among Florida clinicians by assessing variability in: (1) recommendation priorities by patient characteristics and (2) concordance with best practices. METHODS In 2018 and 2019, we conducted a cross-sectional survey incorporating a discrete choice experiment among primary care clinicians (MD/DO, APRN, and PA). We used linear mixed-effects models to determine the importance of patient characteristics (age, sex, time in practice, and chronic condition) and parental concerns. We compared clinician endorsement of predetermined constructs with reported vaccine recommendation statements. RESULTS Among 540 surveys distributed, 272 were returned and 105 reported providing preventive care to 11- to 12-year-olds (43% response rate). Among completing clinicians, 21/99 (21%) did not offer the HPV vaccine. Among clinicians offering the vaccine (n = 78), 35%-37% of each decision to recommend the vaccine was based on the child's age (15 vs. 11 years). For closed-ended questions, most clinicians endorsed best practices including emphasizing cancer prevention (94% for girls and 85% for boys; p = .06), vaccine efficacy (60% both sexes), safety (58% girls and 56% boys), importance at 11-12 years (64% both sexes), and bundling vaccines (35% girls and 31% boys). When clinicians reported their typical recommendation, fewer clinicians incorporated best practices (59% cancer prevention, 5% safety, 8% the importance at 11-12 years, and 8% bundling vaccines). DISCUSSION HPV vaccination recommendation strategies among Florida clinicians somewhat aligned with best practices. Alignment was higher when clinicians were explicitly asked to endorse constructs versus provide recommendations.
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Affiliation(s)
- Stephanie A S Staras
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida; The Institute for Child Health Policy, University of Florida, Gainesville, Florida.
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Eduardo Osegueda
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida; Health Services Research, Management & Policy, College of Public Health & Health Professions, University of Florida, Gainesville, Florida
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Xiaofei Chi
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Vikasni Mohan
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Emily Sage
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Tianyao Huo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Alyson Young
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida; The Institute for Child Health Policy, University of Florida, Gainesville, Florida; Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
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23
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Tensen E, Kuziemsky C, Jaspers MW, Peute LW. General Practitioners' Perspectives About Remote Dermatology Care During the COVID-19 Pandemic in the Netherlands: Questionnaire-Based Study. JMIR DERMATOLOGY 2023; 6:e46682. [PMID: 37632975 PMCID: PMC10335141 DOI: 10.2196/46682] [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: 03/06/2023] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic affected the delivery of primary care and stimulated the use of digital health solutions such as remote digital dermatology care. In the Netherlands, remote store-and-forward dermatology care was already integrated into Dutch general practice before the COVID-19 pandemic. However, it is unclear how general practitioners (GPs) experienced this existing digital dermatology care during the pandemic period. OBJECTIVE We investigated GPs' perspectives about facilitators and barriers related to store-and-forward digital dermatology care during the COVID-19 pandemic in the Netherlands, using a sociotechnical approach. METHODS In December 2021, a web-based questionnaire was distributed via email to approximately 3257 GPs who could perform a digital dermatology consultation and who had started a digital consultation (not necessarily dermatology) in the previous 2 years. The questionnaire consisted of general background questions, questions from a previously validated telemedicine service user satisfaction questionnaire, and newly added questions related to the pandemic and use of the digital dermatology service in general practice. The open-ended and free-text responses were analyzed for facilitators and barriers using content analysis, guided by an 8-dimensional sociotechnical model. RESULTS In total, 71 GPs completed the entire questionnaire, and 66 (93%) questionnaires were included in the data analysis. During the questionnaire distribution period, another national lockdown, social distancing, and stay-at-home mandates were announced; thus, GPs may have had increased workload and limited time to complete the questionnaire. Of the 66 responding GPs, 36 (55%) were female, 25 (38%) were aged 35-44 years, 33 (50%) were weekly platform users, 34 (52%) were working with the telemedicine organization for >5 years, 42 (64%) reported that they used the store-and-forward platform as often during as before the pandemic, 61 (92%) would use the platform again, 53 (80%) would recommend the platform to a colleague, and 10 (15%) used digital dermatology home consultation. Although GPs were generally satisfied with the digital dermatology service, platform, and telemedicine organization, they also experienced crucial barriers to the use of the service during the pandemic. These barriers were GPs' and patients' limited digital photography skills, costs and the lack of appropriate equipment, human-computer interface and interoperability issues on the telemedicine platform, and different use procedures of the digital dermatology service. CONCLUSIONS Although remote dermatology care was already integrated into Dutch GP practice before the pandemic, which may have facilitated the positive responses of GPs about the use of the service, barriers impeded the full potential of its use during the pandemic. Training is needed to improve the use of equipment and quality of (dermoscopy) images taken by GPs and to inform GPs in which circumstances they can or cannot use digital dermatology. Furthermore, the dermatology platform should be improved to also guide patients in taking photographs with sufficient quality.
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Affiliation(s)
- Esmée Tensen
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, Netherlands
- Ksyos Health Management Research, Amsterdam, Netherlands
| | | | - Monique W Jaspers
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, Netherlands
| | - Linda W Peute
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, Netherlands
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Kasonia K, Tindanbil D, Kitonsa J, Baisley K, Zalwango F, Enria L, Mansaray A, James M, Nije Y, Tata DT, Lawal BJ, Drammeh A, Lowe B, Mukadi-Bamuleka D, Mounier-Jack S, Nakiyimba F, Obady P, Muhavi J, Bangura JS, Greenwood B, Samai M, Leigh B, Watson-Jones D, Kavunga-Membo H, Ruzagira E, Gallagher KE. The impact of the COVID-19 pandemic on the provision & utilisation of primary health care services in Goma, Democratic Republic of the Congo, Kambia district, Sierra Leone & Masaka district, Uganda. PLoS One 2023; 18:e0286295. [PMID: 37267240 PMCID: PMC10237403 DOI: 10.1371/journal.pone.0286295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 05/12/2023] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION This study aimed to determine whether the COVID-19 pandemic had an impact on essential primary healthcare services at public primary healthcare facilities. METHODS The number of weekly consultations for antenatal care (ANC), outpatient (OPD), immunisations (EPI), family planning (FP) and HIV services, between January 2018 and December 2020, were collected from 25 facilities in Masaka district, Uganda, 21 in Goma, and 29 in Kambia district, Sierra Leone. Negative binomial regression models accounting for clustering and season were used to analyse changes in activity levels between 2018, 2019 and 2020. RESULTS In Goma, we found no change in OPD, EPI or ANC consultations, FP was 17% lower in March-July 2020 compared to 2019, but this recovered by December 2020. New diagnoses of HIV were 34% lower throughout 2020 compared to 2019. In Sierra Leone, compared to the same periods in 2019, facilities had 18-29% fewer OPD consultations throughout 2020, and 27% fewer DTP3 doses in March-July 2020. There was no evidence of differences in other services. In Uganda there were 20-35% fewer under-5 OPD consultations, 21-66% fewer MCV1 doses, and 48-51% fewer new diagnoses of HIV throughout 2020, compared to 2019. There was no difference in the number of HPV doses delivered. CONCLUSIONS The level of disruption varied across the different settings and qualitatively appeared to correlate with the strength of lockdown measures and reported attitudes towards the risk posed by COVID-19. Mitigation strategies such as health communications campaigns and outreach services may be important to limit the impact of lockdowns on primary healthcare services.
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Affiliation(s)
- K. Kasonia
- LSHTM-INRB Research Partnership, Goma, Democratic Republic of the Congo
| | - D. Tindanbil
- LSHTM-COMAHS Research Partnership, Kambia, Sierra Leone
| | - J. Kitonsa
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - K. Baisley
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - F. Zalwango
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - L. Enria
- LSHTM-COMAHS Research Partnership, Kambia, Sierra Leone
| | - A. Mansaray
- LSHTM-COMAHS Research Partnership, Kambia, Sierra Leone
| | - M. James
- LSHTM-INRB Research Partnership, Goma, Democratic Republic of the Congo
| | - Y. Nije
- LSHTM-COMAHS Research Partnership, Kambia, Sierra Leone
| | - D. Tetsa Tata
- LSHTM-INRB Research Partnership, Goma, Democratic Republic of the Congo
| | - B. J. Lawal
- LSHTM-COMAHS Research Partnership, Kambia, Sierra Leone
| | - A. Drammeh
- LSHTM-COMAHS Research Partnership, Kambia, Sierra Leone
| | - B. Lowe
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - D. Mukadi-Bamuleka
- Laboratoire Rodolphe-Merieux, Institut National de Recherche Biomédicale (INRB-Goma), Goma, Democratic Republic of the Congo
| | - S. Mounier-Jack
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - F. Nakiyimba
- Ministry of Health, Masaka, Masaka District, Uganda
| | - P. Obady
- Ministry of Health, Goma, Democratic Republic of Congo
| | - J. Muhavi
- Ministry of Health, Goma, Democratic Republic of Congo
| | - J. S. Bangura
- University of Sierra Leone College of Medicine and Allied Health Sciences (COMAHS), Freetown, Sierra Leone
- Ministry of Health, Kambia, Kambia District, Sierra Leone
| | - B. Greenwood
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - M. Samai
- University of Sierra Leone College of Medicine and Allied Health Sciences (COMAHS), Freetown, Sierra Leone
| | - B. Leigh
- University of Sierra Leone College of Medicine and Allied Health Sciences (COMAHS), Freetown, Sierra Leone
| | - D. Watson-Jones
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - H. Kavunga-Membo
- Laboratoire Rodolphe-Merieux, Institut National de Recherche Biomédicale (INRB-Goma), Goma, Democratic Republic of the Congo
| | - E. Ruzagira
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - K. E. Gallagher
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
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Wheat CL, Gunnink EJ, Rojas J, Shah A, Nelson KM, Wong ES, Gray KE, Stockdale SE, Rosland AM, Chang ET, Reddy A. Changes in Primary Care Quality Associated With Implementation of the Veterans Health Administration Preventive Health Inventory. JAMA Netw Open 2023; 6:e238525. [PMID: 37067799 PMCID: PMC10111181 DOI: 10.1001/jamanetworkopen.2023.8525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/25/2023] [Indexed: 04/18/2023] Open
Abstract
Importance The COVID-19 pandemic caused significant disruptions in primary care delivery. The Veterans Health Administration (VHA) launched the Preventive Health Inventory (PHI) program-a multicomponent care management intervention, including a clinical dashboard and templated electronic health record note-to support primary care in delivering chronic disease care and preventive care that had been delayed by the pandemic. Objectives To describe patient, clinician, and clinic correlates of PHI use in primary care clinics and to examine associations between PHI adoption and clinical quality measures. Design, Setting, and Participants This quality improvement study used VHA administrative data from February 1, 2021, through February 28, 2022, from a national cohort of 216 VHA primary care clinics that have implemented the PHI. Participants comprised 829 527 veterans enrolled in primary care in clinics with the highest and lowest decile of PHI use as of February 2021. Exposure Templated electronic health record note documenting use of the PHI. Main Outcomes and Measures Diabetes and blood pressure clinical quality measures were the primary outcomes. Interrupted time series models were applied to estimate changes in diabetes and hypertension quality measures associated with PHI implementation. Low vs high PHI use was stratified at the facility level to measure whether systematic differences in uptake were associated with quality. Results A total of 216 primary clinics caring for 829 527 unique veterans (mean [SD] age, 64.1 [16.9] years; 755 158 of 829 527 [91%] were men) formed the study cohort. Use of the PHI varied considerably across clinics. The clinics in the highest decile of PHI use completed a mean (SD) of 32 997.4 (14 019.3) notes in the electronic health record per 100 000 veterans compared with 56.5 (35.3) notes per 100 000 veterans at the clinics in the lowest decile of use (P < .001). Compared with the clinics with the lowest use of the PHI, clinics with the highest use had a larger mean (SD) clinic size (12 072 [7895] patients vs 5713 [5825] patients; P < .001), were more likely to be urban (91% vs 57%; P < .001), and served more non-Hispanic Black veterans (16% vs 5%; P < .001) and Hispanic veterans (14% vs 4%; P < .001). Staffing did not differ meaningfully between high- and low-use clinics (mean [SD] ratio of full-time equivalent staff to clinician, 3.4 [1.2] vs 3.4 [0.8], respectively; P < .001). After PHI implementation, compared with the clinics with the lowest use, those with the highest use had fewer veterans with a hemoglobin A1c greater than 9% or missing (mean [SD], 6577 [3216] per 100 000 veterans at low-use clinics; 9928 [4236] per 100 000 veterans at high-use clinics), more veterans with an annual hemoglobin A1c measurement (mean [SD], 13 181 [5625] per 100 000 veterans at high-use clinics; 8307 [3539] per 100 000 veterans at low-use clinics), and more veterans with adequate blood pressure control (mean [SD], 20 582 [12 201] per 100 000 veterans at high-use clinics; 12 276 [6850] per 100 000 veterans at low-use clinics). Conclusions and Relevance This quality improvement study of the implementation of the VHA PHI suggests that higher use of a multicomponent care management intervention was associated with improved quality-of-care metrics. The study also found significant variation in PHI uptake, with higher uptake associated with clinics with more racial and ethnic diversity and larger, urban clinic sites.
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Affiliation(s)
- Chelle L. Wheat
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Eric J. Gunnink
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Jorge Rojas
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Ami Shah
- Office of Primary Care, Veterans Health Affairs, Washington, DC
| | - Karin M. Nelson
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington, Seattle
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle
| | - Edwin S. Wong
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Kristen E. Gray
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Susan E. Stockdale
- Department of Psychiatry and Biobehavioral Medicine, David Geffen School of Medicine, University of California at Los Angeles
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Ann-Marie Rosland
- Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, Pennsylvania
| | - Evelyn T. Chang
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Division of General Internal Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles
- Division of General Internal Medicine, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Ashok Reddy
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington, Seattle
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle
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Roberts JC, Kulkarni R, Kouides PA, Sidonio RF, Carpenter SL, Konkle BA, Wu J, Ullman MM, Curtis R, Baker JR, Crook N, Nichol MB. Depression and anxiety in persons with Von Willebrand disease. Haemophilia 2023; 29:545-554. [PMID: 36516311 DOI: 10.1111/hae.14725] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 10/17/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We assessed sociodemographic and clinical characteristics associated with depression and anxiety in individuals with Von Willebrand disease (VWD) aged ≥12 years. METHODS The study collected data on patients' sociodemographic, joint problems and health-related quality of life (HRQoL) using EQ-5D-3L, 8-item patient health questionnaire for depression and 7-item Generalized Anxiety Disorder Questionnaire from participants in seven geographically diverse US haemophilia treatment centres. RESULTS Analyses included 77 participants. The rates of depression and anxiety were 63.6% and 58.3%, respectively. Persons with low VWF displayed higher rates of depression (86.7%) or anxiety (69.2%) compared to those with VWD (58.1%, p = .04 for depression, and 55.9%, p = .38 for anxiety). Logistic regression analyses demonstrated that having joint problems (odds ratio [OR] = 6.3, confidence interval [CI] = 2.0-20.1) was the most important variable associated with depression, followed by being single, divorced, widowed, or separated in adult participants or parents of participants age < 18 years (OR = 7.0, CI = 1.7-29.0. The most important variable associated with anxiety was being single or lacking a partner (OR = 10.8, CI = 2.5-47.5), followed by age 12-17 years old (OR = 6.7, CI = 1.6-26.9), or having worse health compared to 3-months ago (OR = 12.3, CI = 1.3-116.2). Mean covariates adjusted EQ visual analogue scale score was significantly lower among persons with depression (68.77 ± 3.15 vs. 77.58 ± 4.24, p = .03) than those without depression. CONCLUSIONS Our study revealed concerning levels of depression and anxiety in this VWD sample. Lack of social support was determined an important factor associated with depression and anxiety in this sample. Mental health screening is critical in VWD clinical evaluation and care.
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Affiliation(s)
| | - Roshni Kulkarni
- Michigan State University Center for Bleeding and Clotting Disorders, East Lansing, Michigan, USA
| | - Peter A Kouides
- Mary M. Gooley Hemophilia Center, Inc., Rochester, New York, USA
| | - Robert F Sidonio
- Emory University & Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | - Barbara A Konkle
- Washington Center for Bleeding Disorders and the University of Washington, Seattle, Washington, USA
| | - Joanne Wu
- University of Southern California, Los Angeles, California, USA
| | - Megan M Ullman
- Gulf States Hemophilia & Thrombophilia Center and University of Texas Health Science Center at Houston, Houston, Texas, USA
| | | | - Judith R Baker
- The Center for Comprehensive Care & Diagnosis of Inherited Blood Disorders, Orange, California, USA
| | - Nicole Crook
- The Center for Comprehensive Care & Diagnosis of Inherited Blood Disorders, Orange, California, USA
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Baldwin LM, Katers LA, Sullivan MD, Gordon DB, James A, Tauben DJ, Arbabi S. Lessons from the implementation of a trauma center-based program to support primary care providers in managing opioids and pain after trauma hospitalization. Trauma Surg Acute Care Open 2023; 8:e001038. [PMID: 36844370 PMCID: PMC9944266 DOI: 10.1136/tsaco-2022-001038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/07/2023] [Indexed: 02/22/2023] Open
Abstract
Background Decreasing exposure to prescription opioids is critical to lowering risk of opioid misuse, overdose and opioid use disorder. This study reports a secondary analysis of a randomized controlled trial implementing an opioid taper support program directed to primary care providers (PCPs) of patients discharged from a level I trauma center to their homes distant from the center, and shares lessons for trauma centers in supporting these patients. Methods This longitudinal descriptive mixed-methods study uses quantitative/qualitative data from trial intervention arm patients to examine implementation challenges and outcomes: adoption, acceptability, appropriateness, feasibility, fidelity. In the intervention, a physician assistant (PA) contacted patients after discharge to review their discharge instructions and pain management plan, confirm their PCP's identity and encourage PCP follow-up. The PA reached out to the PCP to review the discharge instructions and offer ongoing opioid taper and pain management support. Results The PA reached 32 of 37 patients randomized to the program. Of these 32, 81% discussed topics not targeted by the intervention (eg, social/financial). The PA identified and reached a PCP's office for only 51% of patients. Of these, all PCP offices (100% adoption) received one to four consults (mean 1.9) per patient (fidelity). Few consults were with PCPs (22%); most were with medical assistants (56%) or nurses (22%). The PA reported that it was not routinely clear to patients or PCPs who was responsible for post-trauma care and opioid taper, and what the taper instructions were. Conclusions This level I trauma center successfully implemented a telephonic opioid taper support program during COVID-19 but adapted the program to allow nurses and medical assistants to receive it. This study demonstrates a critical need to improve care transition from hospitalization to home for patients discharged after trauma. Level of evidence Level IV.
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Affiliation(s)
- Laura-Mae Baldwin
- Department of Family Medicine and the Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington, USA
| | - Laura A Katers
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Mark D Sullivan
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Debra B Gordon
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Adrienne James
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA
| | - David J Tauben
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Saman Arbabi
- Department of Surgery, University of Washington, Seattle, Washington, USA
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Bojaj G, Tahirbegolli B, Beqiri P, Alloqi Tahirbegolli I, Van Poel E, Willems S, Rizanaj N, Hoxha I. Health Service Management and Patient Safety in Primary Care during the COVID-19 Pandemic in Kosovo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3768. [PMID: 36834461 PMCID: PMC9965489 DOI: 10.3390/ijerph20043768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Several changes must be made to the services to ensure patient safety and enable delivering services in environments where the danger of infection of healthcare personnel and patients in primary care (PC) institutions is elevated, i.e., during the COVID-19 pandemic. OBJECTIVE This study aimed to examine patient safety and healthcare service management in PHC practices in Kosovo during the COVID-19 pandemic. METHODS In this cross-sectional study, data were collected using a self-reported questionnaire among 77 PHC practices. RESULTS Our main finding reveals a safer organization of PC practices and services since the COVID-19 pandemic compared to the previous period before the pandemic. The study also shows a collaboration between PC practices in the close neighborhood and more proper human resource management due to COVID-19 suspicion or infection. Over 80% of the participating PC practices felt the need to introduce changes to the structure of their practice. Regarding infection protection measures (IPC), our study found that health professionals' practices of wearing a ring or bracelet and wearing nail polish improved during the COVID-19 pandemic compared to the pre-pandemic period. During the COVID-19 pandemic, PC practice health professionals had less time to routinely review guidelines or medical literature. Despite this, implementing triage protocols over the phone has yet to be applied at the intended level by PC practices in Kosovo. CONCLUSIONS Primary care practices in Kosovo responded to the COVID-19 pandemic crisis by modifying how they organize their work, implementing procedures for infection control, and enhancing patient safety.
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Affiliation(s)
- Gazmend Bojaj
- Department of Health Institutions and Services Management, Heimerer College, 10000 Prishtina, Kosovo
- Principal Family Medicine Center, 32000 Kline, Kosovo
| | - Bernard Tahirbegolli
- Department of Health Institutions and Services Management, Heimerer College, 10000 Prishtina, Kosovo
- National Sports Medicine Centre, 10000 Prishtina, Kosovo
| | - Petrit Beqiri
- Department of Health Institutions and Services Management, Heimerer College, 10000 Prishtina, Kosovo
| | - Iliriana Alloqi Tahirbegolli
- Laboratory Technician Department, Heimerer College, 10000 Prishtina, Kosovo
- Hematology Clinic, University Clinical Center of Kosovo, 10000 Prishtina, Kosovo
| | - Esther Van Poel
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Nderim Rizanaj
- Nursing Department, Heimerer College, 10000 Prishtina, Kosovo
| | - Ilir Hoxha
- Department of Health Institutions and Services Management, Heimerer College, 10000 Prishtina, Kosovo
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH 03766, USA
- Evidence Synthesis Group, 10000 Prishtina, Kosovo
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29
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Thekkur P, Nair D, Fernando M, Kumar AMV, Satyanarayana S, Chandraratne N, Chandrasiri A, Attygalle DE, Higashi H, Bandara J, Berger SD, Harries AD. Empanelment of the Population to the Primary Medical Care Institution of Sri Lanka: A Mixed-Methods Study on Outcomes and Challenges. Healthcare (Basel) 2023; 11:575. [PMID: 36833109 PMCID: PMC9957292 DOI: 10.3390/healthcare11040575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
The registration of individuals with designated primary medical care institutions (PMCIs) is a key step towards their empanelment with these PMCIs, supported by the Primary Health Care System Strengthening Project in Sri Lanka. We conducted an explanatory mixed-methods study to assess the extent of registration at nine selected PMCIs and understand the challenges therein. By June 2021, 36,999 (19.2%, 95% CI-19.0-19.4%) of the 192,358 catchment population allotted to these PMCIs were registered. At this rate, only 50% coverage would be achieved by the end of the project (December 2023). Proportions of those aged <35 years and males among those registered were lower compared to their general population distribution. Awareness activities regarding registration were conducted in most of the PMCIs, but awareness in the community was low. Poor registration coverage was due to a lack of dedicated staff for registration, misconceptions of health care workers about individuals needing to be registered, reliance on opportunistic or passive registration, and lack of monitoring mechanisms; these were further compounded by the COVID-19 pandemic. Moving forward, there is an urgent need to address these challenges to improve registration coverage and ensure that all individuals are empaneled before the close of the project for it to have a meaningful impact.
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Affiliation(s)
- Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
| | - Divya Nair
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
| | - Manoj Fernando
- Department of Health Promotion, Rajarata University of Sri Lanka, Mihintale, Anuradhapura 50300, Sri Lanka
| | - Ajay M. V. Kumar
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- The Union-South East Asia (USEA) Office, New Delhi 110016, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore 575018, India
| | - Srinath Satyanarayana
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- The Union-South East Asia (USEA) Office, New Delhi 110016, India
| | - Nadeeka Chandraratne
- The Foundation for Health Promotion, 21/1 Kahawita Road, Dehiwala 10350, Sri Lanka
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo 00300, Sri Lanka
| | - Amila Chandrasiri
- The Foundation for Health Promotion, 21/1 Kahawita Road, Dehiwala 10350, Sri Lanka
| | | | | | - Jayasundara Bandara
- Project Management Unit, Primary Health Care System Strengthening Project (PSSP), Colombo 00300, Sri Lanka
| | - Selma Dar Berger
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
| | - Anthony D. Harries
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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30
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Pogorzelska K, Marcinowicz L, Chlabicz S. A Qualitative Study of Primary Care Physicians' Experiences with Telemedicine during the COVID-19 Pandemic in North-Eastern Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1963. [PMID: 36767329 PMCID: PMC9915015 DOI: 10.3390/ijerph20031963] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 06/17/2023]
Abstract
(1) Background: Due to the COVID-19 pandemic, primary care clinics quickly moved to provide medical consultations via telemedicine, however, information about primary care professionals' perspectives is limited. (2) Methods: Thirty semi-structured interviews with primary care professionals working in north-eastern Poland were conducted to assess their perspectives regarding the benefits and challenges of telemedicine. (3) Results: Primary care professionals highlighted that telemedicine increases access to medical services and reduces travel inconvenience. Remote consultation is not as time-consuming as in-person visits, which enables the provision of medical services to a greater number of patients which is particularly important in primary care. The inability to see patients and loss of non-verbal communication represent a significant difficulty in providing remote care. Primary care professionals indicated patients are not always able to express themselves sufficiently in a telephone call, which leads to performing medical consultations inefficiently. Physicians also pointed out that in particular medical cases, physical contact is still necessary to reach an accurate diagnosis and give the necessary treatment. Statements of the study participants also show that primary care professionals are satisfied with providing medical advice with telemedicine and show their interest in continuing remote consultation in the post-COVID era. (4) Conclusions: Primary care professionals have moved towards incorporating telemedicine into their daily routines due to the COVID-19 pandemic. Despite the many difficulties encountered, healthcare professionals have also noticed the benefits of telemedicine, especially during challenging circumstances. The study shows telemedicine to be a valuable tool in caring for patients, although it should be emphasized that face-to-face consultations cannot be fully replaced by remote consultations.
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Affiliation(s)
- Karolina Pogorzelska
- Department of Family Medicine, Medical University of Bialystok, 15054 Bialystok, Poland
| | - Ludmila Marcinowicz
- Department of Obstetrics, Gynecology and Maternity Care, Medical University of Bialystok, 15295 Bialystok, Poland
| | - Slawomir Chlabicz
- Department of Family Medicine, Medical University of Bialystok, 15054 Bialystok, Poland
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Khalil-Khan A, Khan MA. The Impact of COVID-19 on Primary Care: A Scoping Review. Cureus 2023; 15:e33241. [PMID: 36618499 PMCID: PMC9815485 DOI: 10.7759/cureus.33241] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
The COVID-19 pandemic had a severe impact on various aspects of everyday life, including healthcare provision. The aim of the scoping review was to collate, summarize, and discuss this literature, in light of the impact COVID-19 had on Primary care. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) four-stage process framework for reporting was followed. A total of 31 studies were included in this review. Based upon our review we found COVID-19 pandemic on Primary Care, has made significant effects on 1) service redesign, 2) long-term illness care provision, 3) healthcare staff well-being and 4) the post-pandemic future of Primary Care. The COVID-19 outbreak has demonstrated, how a pandemic can drastically change the process of healthcare provision within the community, as evidenced by the change in consultation styles with patients, the impact on the physical and mental wellbeing of health workers, a shift from isolated practice to teamwork, as well as the ability of healthcare workers to seek prompt help with their health. Studies have demonstrated progress in knowledge and experience gained by healthcare workers when tackling COVID-19, and how these can be implemented in possible future pandemics affecting Primary Care, however, further research is required within this sphere.
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Affiliation(s)
- Alam Khalil-Khan
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, GBR
| | - Moien Ab Khan
- Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, ARE
- Primary Care, North West London - National Health Service Provider, London, GBR
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32
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Siebenhofer A, Scott AM, Avian A, Terebessy A, Mergenthal K, Schaffler-Schaden D, Bachler H, Huter S, Zelko E, Murray A, Guppy M, Piccoliori G, Streit S, Jeitler K, Flamm M. COVI-Prim international: Similarities and discrepancies in the way general practices from seven different countries coped with the COVID-19 pandemic. Front Public Health 2022; 10:1072515. [PMID: 36600939 PMCID: PMC9806865 DOI: 10.3389/fpubh.2022.1072515] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives General practitioners (GPs) are frequently patients' first point of contact with the healthcare system and play an important role in identifying, managing and monitoring cases. This study investigated the experiences of GPs from seven different countries in the early phases of the COVID-19 pandemic. Design International cross-sectional online survey. Setting General practitioners from Australia, Austria, Germany, Hungary, Italy, Slovenia and Switzerland. Participants Overall, 1,642 GPs completed the survey. Main outcome measures We focused on how well-prepared GPs were, their self-confidence and concerns, efforts to control the spread of the disease, patient contacts, information flow, testing procedures and protection of staff. Results GPs gave high ratings to their self-confidence (7.3, 95% CI 7.1-7.5) and their efforts to control the spread of the disease (7.2, 95% CI 7.0-7.3). A decrease in the number of patient contacts (5.7, 95% CI 5.4-5.9), the perception of risk (5.3 95% CI 4.9-5.6), the provision of information to GPs (4.9, 95% CI 4.6-5.2), their testing of suspected cases (3.7, 95% CI 3.4-3.9) and their preparedness to face a pandemic (mean: 3.5; 95% CI 3.2-3.7) were rated as moderate. GPs gave low ratings to their ability to protect staff (2.2 95% CI 1.9-2.4). Differences were identified in all dimensions except protection of staff, which was consistently low in all surveyed GPs and countries. Conclusion Although GPs in the different countries were confronted with the same pandemic, its impact on specific aspects differed. This partly reflected differences in health care systems and experience of recent pandemics. However, it also showed that the development of structured care plans in case of future infectious diseases requires the early involvement of primary care representatives.
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Affiliation(s)
- Andrea Siebenhofer
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria
- Institute of General Practice, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QL, Australia
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - András Terebessy
- Department of Public Health-Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Karola Mergenthal
- Institute of General Practice, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Dagmar Schaffler-Schaden
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Herbert Bachler
- Institute of General Practice, Medical University of Innsbruck, Innsbruck, Austria
| | - Sebastian Huter
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Erika Zelko
- Faculty of Medicine, Johannes Kepler University of Linz, Linz, Austria
| | - Amanda Murray
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QL, Australia
| | - Michelle Guppy
- School of Rural Medicine and New England GP Research Network, University of New England, Armidale, NSW, Australia
| | - Giuliano Piccoliori
- Institute for Special Training in General Medicine, Institute of General Practice, Claudiana Bozen, Bolzano, Italy
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Klaus Jeitler
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Maria Flamm
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
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Oleszczyk M, Marciniak Z, Nessler K, Wójtowicz E, Szozda N, Kryj-Radziszewska E, Boroń M, Gajos K, Paziewski MP, Sajdak P, Windak A. COVID-19 vaccine short-term adverse events in the real-life family practice in Krakow, Poland. Eur J Gen Pract 2022:1-9. [DOI: 10.1080/13814788.2022.2147500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Marek Oleszczyk
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Zuzanna Marciniak
- Family Medicine Student Interest Group, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
- The Ludwik Rydygier Viovodship Hospital, Krakow, Poland
| | - Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Ewa Wójtowicz
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Nataliya Szozda
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
- Department of Family and Community Medicine, University of Toronto/Toronto Western Hospital PGY1, Toronto, Canada
| | | | - Maria Boroń
- Family Medicine Student Interest Group, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
- Independent Public Health Care Center, Myślenice, Poland
| | - Klaudia Gajos
- Family Medicine Student Interest Group, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz P. Paziewski
- Family Medicine Student Interest Group, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Sajdak
- Family Medicine Student Interest Group, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
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Gleeson LL, Ludlow A, Clyne B, Ryan B, Argent R, Barlow J, Mellon L, De Brún A, Pate M, Kirke C, Moriarty F, Flood M. Pharmacist and patient experiences of primary care during the COVID-19 pandemic: An interview study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 8:100193. [PMID: 36268130 PMCID: PMC9557137 DOI: 10.1016/j.rcsop.2022.100193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/18/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction A number of significant changes designed to reduce the spread of COVID-19 were introduced in primary care during the COVID-19 pandemic. In Ireland, these included fundamental legislative and practice changes such as permitting electronic transfer of prescriptions, extending duration of prescription validity, and encouraging virtual consultations. Although such interventions served an important role in preventing the spread of infection, their impact on practice and patient care is not yet clear. The aim of this study was to investigate patient and healthcare professional (pharmacist and general practitioner) experiences to understand the impact of COVID-19 on primary care and medication safety during the first two years of the COVID-19 pandemic in Ireland. Methods A qualitative study using semi-structured interviews was undertaken between October 2021 and January 2022. Participants included twelve patients, ten community pharmacists, and one general practitioner. Interviews were transcribed verbatim and analysed using thematic analysis. Only patient and pharmacist interviews were included. Findings Themes from the interviews included: 1) Access to care, 2) Technological changes, 3) Experiences of care, and 4) Patient safety. Particular challenges identified included the difficulty faced by patients when accessing care, impacts on experiences of patient care, and extensive changes to pharmacy practice during the pandemic. Conclusions This study found that COVID-19 countermeasures considerably impacted patient and pharmacist experiences of primary care in terms of care and medication safety. While many changes were welcomed, others such as virtual consultations were received more cautiously likely due to the rapid and unplanned nature of their introduction. Further research is needed to identify how to optimise these changes to improve pharmacist and patient experience, and to understand the impact on patient safety.
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Affiliation(s)
- Laura L. Gleeson
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Aoife Ludlow
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Ben Ryan
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Rob Argent
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - James Barlow
- Department of Pharmaceutical and Medicinal Chemistry, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Lisa Mellon
- Department of Health Psychology, School of Population Health, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland
| | - Muriel Pate
- National Quality and Patient Safety Directorate, Health Service Executive, Dr Steevens' Hospital, Dublin 8, Ireland
| | - Ciara Kirke
- National Quality and Patient Safety Directorate, Health Service Executive, Dr Steevens' Hospital, Dublin 8, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Michelle Flood
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
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Abstract
This report of the European Food Safety Authority and the European Centre for Disease Prevention and Control presents the results of zoonoses monitoring and surveillance activities carried out in 2021 in 27 MSs, the United Kingdom (Northern Ireland) and nine non-MSs. Key statistics on zoonoses and zoonotic agents in humans, food, animals and feed are provided and interpreted historically. In 2021, the first and second most reported zoonoses in humans were campylobacteriosis and salmonellosis, respectively. Cases of campylobacteriosis and salmonellosis increased in comparison with 2020, but decreased compared with previous years. In 2021, data collection and analysis at the EU level were still impacted by the COVID-19 pandemic and the control measures adopted in the MSs, including partial or total lockdowns. Sixteen MSs and the United Kingdom (Northern Ireland) achieved all the established targets in poultry populations for reduction in Salmonella prevalence for the relevant serovars. Salmonella samples from carcases of various animal species and samples for Campylobacter quantification from broiler carcases were more frequently positive when performed by the competent authorities than when own-checks were conducted. Yersiniosis was the third most reported zoonosis in humans, followed by Shiga toxin-producing Escherichia coli (STEC) and Listeria monocytogenes infections. L. monocytogenes and West Nile virus infections were the most severe zoonotic diseases, with the most hospitalisations and highest case fatality rates. Overall, MSs reported more foodborne outbreaks and cases in 2021 than in 2020. S. Enteritidis remained the most frequently reported causative agent for foodborne outbreaks. Salmonella in 'eggs and egg products' and in 'mixed foods' were the agent/food pairs of most concern. Outbreaks linked to 'vegetables and juices and products thereof' rose considerably compared with previous years. This report also provides updates on brucellosis, Coxiella burnetii (Q fever), echinococcosis, rabies, toxoplasmosis, trichinellosis, tuberculosis due to Mycobacterium bovis or M. caprae, and tularaemia.
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Contributions of nursing students during their clinical practice in primary care: Adaptation and validation of a scale. Nurse Educ Pract 2022; 65:103496. [DOI: 10.1016/j.nepr.2022.103496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
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Budrevičiūtė A, Raila G, Paukštaitienė R, Valius L. An analysis of the causes of exhaustion among physicians working in family physician teams during the COVID-19 pandemic in Lithuania. PLoS One 2022; 17:e0274360. [PMID: 36301891 PMCID: PMC9612553 DOI: 10.1371/journal.pone.0274360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background The COVID-19 pandemic had a severe impact on public life around the world, influencing medicine and health, the economy, employment, science, and education. Health care specialists are key workers who faced extreme challenges posed by the pandemic, including threats to their own lives due to the rapid spread of the virus, a huge increase in workload, and professional burnout syndrome. Analysis of the factors that physicians found most exhausting during the pandemic could lay the groundwork for the effective management of future crises. Objective To identify the factors that physicians working in family physician (family and internal medicine) teams found most exhausting during the COVID-19 pandemic in Lithuania and assess their causes. Methods An anonymous survey of physicians (n = 191) working in family physician teams was carried out from 21 June 2021 to 17 September 2021. Physicians signed an informed consent form prior to completion of the questionnaire. Mixed data analysis was performed, consisting of statistical analysis using the SPSS 27 software and a qualitative causal analysis. Results During the pandemic, physicians were most exhausted by: chaotic vaccination priorities (44.5%); unsatisfied patients (52.4%); constantly changing legislation (71.7%); the large workload (75.9%); and the malfunctioning of online systems (81.2%). Conclusions Physicians in family physician teams indicated the following aspects that require improvement: service provision; effective work organization for physicians; and the satisfaction of patients with decisions made during the pandemic.
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Affiliation(s)
- Aida Budrevičiūtė
- Independent Scientist, Chief Researcher of the Biomedical Study “Challenges of COVID-19 in Family Medicine”, Vilnius, Lithuania
- * E-mail:
| | - Gediminas Raila
- Department of Family Medicine, Department of Family Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Renata Paukštaitienė
- Department of Physics, Mathematics, and Biophysics, Lithuanian University of Health Sciences, Medical Academy, Kaunas, Lithuania
| | - Leonas Valius
- Department of Family Medicine, Department of Family Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Roberts R, Johnson C, Hopwood M, Firth J, Jackson K, Sara G, Allan J, Calder R, Manger S. The Potential Impact of a Public Health Approach to Improving the Physical Health of People Living with Mental Illness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11746. [PMID: 36142019 PMCID: PMC9516962 DOI: 10.3390/ijerph191811746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 06/16/2023]
Abstract
With already wide disparities in physical health and life expectancy, COVID-19 presents people with mental illness with additional threats to their health: decreased access to health services, increased social isolation, and increased socio-economic disadvantage. Each of these factors has exacerbated the risk of poor health and early death for people with mental illness post-COVID-19. Unless effective primary care and preventative health responses are implemented, the physical illness epidemic for this group will increase post the COVID-19 pandemic. This perspective paper briefly reviews the literature on the impact of COVID-19 on service access, social isolation, and social disadvantage and their combined impact on physical health, particularly cancer, respiratory diseases, heart disease, smoking, and infectious diseases. The much-overlooked role of poor physical health on suicidality is also discussed. The potential impact of public health interventions is modelled based on Australian incidence data and current research on the percentage of early deaths of people living with mental illnesses that are preventable. Building on the lessons arising from services' response to COVID-19, such as the importance of ensuring access to preventive, screening, and primary care services, priority recommendations for consideration by public health practitioners and policymakers are presented.
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Affiliation(s)
- Russell Roberts
- Faculty of Business, Justice and Behavioural Science, Charles Sturt University, Bathurst, NSW 2795, Australia
| | - Caroline Johnson
- Melbourne Medical School, University of Melbourne, Parkville, VIC 3010, Australia
| | - Malcolm Hopwood
- Melbourne Medical School, University of Melbourne, Parkville, VIC 3010, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester M13 9PL, UK
| | - Kate Jackson
- NSW Ministry of Health, St Leonards, NSW 2065, Australia
| | - Grant Sara
- NSW Ministry of Health, St Leonards, NSW 2065, Australia
- Sydney Medical School, Northern Clinical School, University of Sydney, Sydney, NSW 2001, Australia
| | - John Allan
- Queensland Health, University of Queensland, Brisbane, QLD 4072, Australia
| | - Rosemary Calder
- Mitchell Institute, Victoria University, Melbourne, VIC 3000, Australia
| | - Sam Manger
- College of Dentistry and Medicine, James Cook University, Townsville, QLD 4811, Australia
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Melki S, Ben Hassine D, Chebil D, Nouira S, Zanina Y, Ben Abdelaziz A. Perception of Tunisian Public Health Practitioners on the Role of Primary Health Care during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11118. [PMID: 36078834 PMCID: PMC9517812 DOI: 10.3390/ijerph191711118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/18/2022] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
CONTEXT Primary Health Care is the first level of healthcare delivery services. Its role in the management of epidemics has been documented especially during the SARS and Ebola epidemics, and more recently during the COVID-19 pandemic. OBJECTIVE To describe public health experts' perceptions of the implication of Primary Health Care on managing the COVID-19 pandemic in Tunisia. METHODS This qualitative study was based on a structured interview covering five domains: 1. Preparedness, 2. Implication, 3. Health delivery, 4. Response and 5. Fight against COVID-19 in Primary Health Care in Tunisia. Convenient sampling was done to include public health practitioners and experts. RESULTS A total of 25 experts were included with a sex ratio that was equal to 0.92, including two international experts, and four that were working in the Ministry of Health. The majority of respondents affirmed that the Tunisian PHC was not prepared to fight against the COVID-19 pandemic. Concerning the response role of PHC against COVID-19, some experts stated that PHC played an important role in the early stages of the pandemic. Almost all included participants claimed that PHC was marginalized from the national strategy against COVID-19. In addition, all respondents affirmed that there had been a weakening effect of the delivery of the minimum healthcare package that was dispended by the PHC after the pandemic. However, they all expressed the ability of PHC to manage future epidemics. CONCLUSION The Tunisian PHC system did not play an efficient role in the current COVID-19 pandemic. However future lessons should be deduced for further implications in potential upcoming epidemics.
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Affiliation(s)
- Sarra Melki
- Information System Direction, University Hospital of Sahloul, Sousse 4054, Tunisia
- Sousse Faculty of Medicine, University of Sousse, Sousse 4002, Tunisia
- Research Laboratory LR19SP01, Sousse 4054, Tunisia
| | - Donia Ben Hassine
- Research Laboratory LR19SP01, Sousse 4054, Tunisia
- Monastir Faculty of Medicine, University of Monastir, Monastir 5000, Tunisia
| | - Dhekra Chebil
- Sousse Faculty of Medicine, University of Sousse, Sousse 4002, Tunisia
- Research Laboratory LR19SP01, Sousse 4054, Tunisia
| | - Sarra Nouira
- Research Laboratory LR19SP01, Sousse 4054, Tunisia
- Monastir Faculty of Medicine, University of Monastir, Monastir 5000, Tunisia
| | - Youssef Zanina
- Monastir Faculty of Pharmacy, University of Monastir, Monastir 5000, Tunisia
| | - Ahmed Ben Abdelaziz
- Information System Direction, University Hospital of Sahloul, Sousse 4054, Tunisia
- Sousse Faculty of Medicine, University of Sousse, Sousse 4002, Tunisia
- Research Laboratory LR19SP01, Sousse 4054, Tunisia
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Silva B, Ožvačić Adžić Z, Vanden Bussche P, Van Poel E, Seifert B, Heaster C, Collins C, Tuz Yilmaz C, Knights F, de la Cruz Gomez Pellin M, Astier Peña MP, Stylianou N, Gomez Bravo R, Cerovečki V, Klemenc Ketis Z, Willems S. Safety Culture and the Positive Association of Being a Primary Care Training Practice during COVID-19: The Results of the Multi-Country European PRICOV-19 Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10515. [PMID: 36078230 PMCID: PMC9518383 DOI: 10.3390/ijerph191710515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
The day-to-day work of primary care (PC) was substantially changed by the COVID-19 pandemic. Teaching practices needed to adapt both clinical work and teaching in a way that enabled the teaching process to continue, while maintaining safe and high-quality care. Our study aims to investigate the effect of being a training practice on a number of different outcomes related to the safety culture of PC practices. PRICOV-19 is a multi-country cross-sectional study that researches how PC practices were organized in 38 countries during the pandemic. Data was collected from November 2020 to December 2021. We categorized practices into training and non-training and selected outcomes relating to safety culture: safe practice management, community outreach, professional well-being and adherence to protocols. Mixed-effects regression models were built to analyze the effect of being a training practice for each of the outcomes, while controlling for relevant confounders. Of the participating practices, 2886 (56%) were non-training practices and 2272 (44%) were training practices. Being a training practice was significantly associated with a lower risk for adverse mental health events (OR: 0.83; CI: 0.70-0.99), a higher number of safety measures related to patient flow (Beta: 0.17; CI: 0.07-0.28), a higher number of safety incidents reported (RR: 1.12; CI: 1.06-1.19) and more protected time for meetings (Beta: 0.08; CI: 0.01-0.15). No significant associations were found for outreach initiatives, availability of triage information, use of a phone protocol or infection prevention measures and equipment availability. Training practices were found to have a stronger safety culture than non-training practices. These results have important policy implications, since involving more PC practices in education may be an effective way to improve quality and safety in general practice.
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Affiliation(s)
- Bianca Silva
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Zlata Ožvačić Adžić
- Department of Family Medicine, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Health Centre Zagreb-Centar, 10000 Zagreb, Croatia
| | | | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Bohumil Seifert
- Institute of General Practice, First Medical Faculty, Charles University, CZ-121 08 Prague, Czech Republic
| | - Cindy Heaster
- Department of Family Medicine, Faculty of Medicine, Riga Stradiņš University, LV-1007 Riga, Latvia
| | - Claire Collins
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
| | - Canan Tuz Yilmaz
- Family Medicine Department, Bursa Uludag University, 16130 Bursa, Turkey
| | - Felicity Knights
- Population Health Research Institute, St George’s University of London, London SW17 0RE, UK
| | | | - Maria Pilar Astier Peña
- Primary Health Centre Universitas, Aragon Health Services, 50009 Zaragoza, Spain
- Medical School, Universidad de Zaragoza, GIBA-ISS-Aragón, 50009 Zaragoza, Spain
| | - Neophytos Stylianou
- RTD Talos, 2404 Nicosia, Cyprus
- International Institute for Compassionate Care, 2415 Nicosia, Cyprus
| | - Raquel Gomez Bravo
- CHNP, Rehaklinik, L-9002 Ettelbruck, Luxembourg
- Research Group Self-Regulation and Health, Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, Faculty of Humanities, Education and Social Sciences, University of Luxembourg, L-4366 Esch-sur-Alzette, Luxembourg
| | - Venija Cerovečki
- Department of Family Medicine, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Health Centre Zagreb-Centar, 10000 Zagreb, Croatia
| | - Zalika Klemenc Ketis
- Ljubljana Community Health Centre, 1000 Ljubljana, Slovenia
- Department of Family Medicine, Medical Faculty, University of Maribor, 2000 Maribor, Slovenia
- Department of Family Medicine, Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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Ah-Thiane L, Ferrer L, Maucherat B, Fleury V, Le Thiec M, Rusu D, Rousseau C. Vaccine-Related Lymph Nodes: The Emerging Pitfalls of 18F-Fluorocholine and 68Ga-PSMA-11 PET/CT in the Era of COVID-19 Vaccination. Clin Nucl Med 2022; 47:575-582. [PMID: 35675134 PMCID: PMC9169609 DOI: 10.1097/rlu.0000000000004190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Vaccination against coronavirus disease 2019 (COVID-19) is currently under worldwide deployment. The consequences of this vaccination can be seen in radiology and nuclear medicine explorations with visualization of axillary lymph nodes (LNs), as observed on ultrasonography, MRI, or 18F-FDG PET/CT.We aimed to evaluate on PET/CT the incidence of vaccine-related LNs and their characteristics after COVID-19 vaccination, using several radiopharmaceuticals different from 18F-FDG. PATIENTS AND METHODS Between February and July 2021, all consecutive patients undergoing a whole-body PET/CT for any indication using a different radiopharmaceutical from 18F-FDG were eligible for inclusion if they had received at least 1 dose of the COVID-19 vaccine. The radiopharmaceutical administered and vaccine type were recorded for each patient. The incidence of positive vaccine-related axillary and supraclavicular LNs on PET/CT was our primary finding, along with the nodes characteristics. Statistical analyses were performed for patients with prostate cancer (PCa) to determine certain interaction factors that were associated with the detection of vaccine-related LNs. RESULTS Of the 226 patients in our cohort study, 120 patients underwent an 18F-fluorocholine PET/CT, 79 a 68Ga-PSMA-11 PET/CT, 6 an 18F-FDOPA PET/CT, and 21 a 68Ga-DOTATOC PET/CT. A total of 67.3% of patients (152/226) received BNT162b2mRNA (Pfizer-BioNTech), 26.5% (60/226) ChAdOx1-S (AstraZeneca), 4.9% (11/226) mRNA-1273 (Moderna), and 1.3% (3/226) Ad26.COV2.S (Janssen). The incidence of positive vaccine-related axillary and supraclavicular LNs was 42.5% (51/120 patients) on PET/CT using 18F-fluorocholine and 12.7% (10/79 patients) with 68Ga-PSMA-11. None of our patients undergoing 18F-FDOPA or 68Ga-DOTATOC PET/CT presented any vaccine-related lymphadenopathy. Vaccine-related LNs were statistically associated with the nature of the radiopharmaceutical (P < 10-4), with the number of vaccine doses received (P = 0.041), with a short delay between vaccination and PET/CT realization (P < 10-5), and with a higher prostate-specific antigen level for patients with PCa (P = 0.032), but not with age or vaccine type. The vaccine-related nodes appeared in 85% of the cases, in the 30 days after vaccine injection, were limited in size and uptake, and were most often limited to the axilla level 1 area. CONCLUSIONS Detecting positive LNs after COVID-19 vaccination is not an exclusive 18F-FDG PET/CT pattern but is common on 18F-fluorocholine and possible on 68Ga-PSMA-11 PET/CT. Confronting PET/CT findings with clinical data (such as date and site of injection) seems essential in the current pandemic context, just as it does for the radiopharmaceuticals used in PCa to avoid PET/CT misinterpretation and incorrect patient treatment. For 18F-FDOPA or 68Ga-DOTATOC PET/CT, this seems to have a lesser impact.
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Affiliation(s)
| | - Ludovic Ferrer
- From the ICO René Gauducheau, Saint-Herblain
- CRCI2NA, UMR 1307 Inserm - UMR 6075 CNRS, Nantes, France
| | | | | | | | | | - Caroline Rousseau
- From the ICO René Gauducheau, Saint-Herblain
- CRCI2NA, UMR 1307 Inserm - UMR 6075 CNRS, Nantes, France
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Collins C, Van Poel E, Šantrić Milićević M, Tripkovic K, Adler L, Bjerve Eide T, Murauskiene L, Windak A, Nessler K, Tahirbegolli B, Willems S. Practice and System Factors Impact on Infection Prevention and Control in General Practice during COVID-19 across 33 Countries: Results of the PRICOV Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7830. [PMID: 35805489 PMCID: PMC9265277 DOI: 10.3390/ijerph19137830] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 01/14/2023]
Abstract
Infection prevention and control (IPC) is an evidence-based approach used to reduce the risk of infection transmission within the healthcare environment. Effective IPC practices ensure safe and quality healthcare. The COVID-19 pandemic highlighted the need for enhanced IPC measures and the World Health Organization (WHO) emphasized the need for strict adherence to the basic principles of IPC. This paper aims to describe the IPC strategies implemented in general practice during the COVID-19 pandemic and to identify the factors that impact their adoption. Data were collected by means of an online self-reported questionnaire among general practices. Data from 4466 practices in 33 countries were included in the analysis. Our results showed a notable improvement in IPC during COVID-19 with more practices reporting that staff members never wore nail polish (increased from 34% to 46.2%); more practices reporting that staff never wear a ring/bracelet (increased from 16.1% to 32.3%); and more practices using a cleaning protocol (increased from 54.9% to 72.7%). Practice population size and the practice payment system were key factors related to adoption of a) range of IPC measures including patient flow arrangements and infrastructural elements. An understanding of the interplay between policy, culture, systemic supports, and behavior are necessary to obtain sustained improvement in IPC measures.
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Affiliation(s)
- Claire Collins
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium; (E.V.P.); (S.W.)
| | | | | | - Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | | | - Liubove Murauskiene
- Public Health Department, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania;
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, 31-061 Krakow, Poland; (A.W.); (K.N.)
| | - Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, 31-061 Krakow, Poland; (A.W.); (K.N.)
| | - Bernard Tahirbegolli
- Management of Health Institutions and Services, Heimerer College, 10000 Prishtina, Kosovo;
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium; (E.V.P.); (S.W.)
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Hangartner N, Di Gangi S, Elbl C, Senn O, Bisatz F, Fehr T. Impact of the COVID-19 pandemic on emergency outpatient consultations and admissions of non-COVID-19 patients (ECCO)-A cross-sectional study. PLoS One 2022; 17:e0269724. [PMID: 35687575 PMCID: PMC9187104 DOI: 10.1371/journal.pone.0269724] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
During the first year of the COVID-19 pandemic, healthcare facilities worldwide struggled to adequately care for the increasing number of COVID-19 patients while maintaining quality of care for all other patients. The aim of this study was to investigate the displacement and underuse of non-COVID-19 patient care in a medical department of a tertiary hospital in Switzerland. In this retrospective cross-sectional study, internal medicine admissions from 2017 to 2020, emergency outpatient visits from 2019 to 2020 and COVID-19 admissions in 2020 were analyzed and compared using a regression model. Internal medicine admissions were also stratified by diagnosis. A questionnaire was used to assess the pandemic experience of local general practitioners, referring hospitals, and nursing homes. The total number of admissions decreased during the 1st and 2nd waves of the pandemic but increased between the two waves. Elective admissions decreased in 2020 compared to pre-pandemic years: they represented 25% of total admissions in 2020 versus 30% of the total admissions during 2017-2019, p <0.001. Admissions for emergency reasons increased: 71% in 2020 versus 65% in 2017-2019, p < 0.001. Emergency outpatient consultations decreased in 2020 compared to 2019, 62.77 (14.70), mean (SD), weekly visits in 2020 versus 74.13 (13.98) in 2019, p<0.001. Most general practitioners and heads of referring hospitals also reported a decrease in consultations, especially during the 1st wave of the pandemic. Mental illnesses, anxiety or burn-out were perceived in both patients and staff in general practices and nursing homes. In conclusion, the COVID-19 pandemic negatively affected the care of non-COVID-19 patients, particularly those with chronic illnesses. A shift of health care resources from non-COVID patients to COVID patients was observed. These findings could help institutions better manage such a situation in the future.
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Affiliation(s)
- Nina Hangartner
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Stefania Di Gangi
- Institute of Primary Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Elbl
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Oliver Senn
- Institute of Primary Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Fadri Bisatz
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Thomas Fehr
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
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Edwards J, Coward M, Carey N. Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review. BMJ Open 2022; 12:e052227. [PMID: 35676011 PMCID: PMC9185484 DOI: 10.1136/bmjopen-2021-052227] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/27/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To support workforce deficits and rising demand for medicines, independent prescribing (IP) by nurses, pharmacists and allied health professionals is a key component of workforce transformation in UK healthcare. This systematic review of qualitative research studies used a thematic synthesis approach to explore stakeholders' views on IP in primary care and identify barriers and facilitators influencing implementation. SETTING UK primary/community care. PARTICIPANTS Inclusion criteria were UK qualitative studies of any design, published in the English language. Six electronic databases were searched between January 2010 and September 2021, supplemented by reference list searching. Papers were screened, selected and quality-appraised using the Quality Assessment Tool for Studies with Diverse Designs. Study data were extracted to a bespoke table and two reviewers used NVivo software to code study findings. An inductive thematic synthesis was undertaken to identify descriptive themes and interpret these into higher order analytical themes. The Diffusion of Innovations and Consolidated Framework for Implementation Research were guiding theoretical anchors. PRIMARY AND SECONDARY OUTCOME MEASURES N/A. RESULTS Twenty-three articles addressing nurse, pharmacist and physiotherapist IP were included. Synthesis identified barriers and facilitators in four key stages of implementation: (1) 'Preparation', (2) 'Training', (3) 'Transition' and 4) 'Sustainment'. Enhancement, substitution and role-specific implementation models reflected three main ways that the IP role was used in primary care. CONCLUSIONS In order to address global deficits, there is increasing need to optimise use of IP capability. Although the number of independent prescribers continues to grow, numerous barriers to implementation persist. A more coordinated and targeted approach is key to overcoming barriers identified in the four stages of implementation and would help ensure that IP is recognised as an effective approach to help alleviate workforce shortfalls in the UK, and around the world. PROSPERO REGISTRATION NUMBER CRD42019124400.
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Affiliation(s)
- Judith Edwards
- School of Health Sciences, University of Surrey Faculty of Health and Medical Sciences, Guildford, UK
| | - Melaine Coward
- School of Health Sciences, University of Surrey Faculty of Health and Medical Sciences, Guildford, UK
| | - Nicola Carey
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
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Gleeson LL, Ludlow A, Wallace E, Argent R, Collins C, Clyne B, Mellon L, Barlow JW, Ryan B, De Brún A, Holton A, Pate M, Kirke C, Flood M, Moriarty F. Changes to primary care delivery during the COVID-19 pandemic and perceived impact on medication safety: A survey study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 6:100143. [PMID: 35702683 PMCID: PMC9182324 DOI: 10.1016/j.rcsop.2022.100143] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction The COVID-19 pandemic has had a profound impact on the delivery of primary care around the world. In Ireland, the use of technologies such as virtual consultations and the electronic transfer of prescriptions became widespread in order to deliver care to patients while minimising infection risk. The impact of these changes on medication safety is not yet known. Objectives The aims of this survey study were to investigate 1) the changes that have occurred in Irish primary care since the start of the COVID-19 pandemic and 2) the impact of these changes on medication safety. Methods Anonymous, online surveys were distributed to general practitioners (GPs) and pharmacists from August-September 2021. Surveys contained quantitative (multiple-choice, Likert scale) and qualitative (free-text) questions concerning workflow changes, medication safety incidents and near misses, and GP/pharmacist perspectives on medication safety and COVID-19. Reported medication safety incidents and near misses were categorised according to the WHO Conceptual Framework for the International Classification for Patient Safety. Results In total, there were 251 responses to the survey, comprising of 211 pharmacists and 40 GPs. The most significant workflow changes during the pandemic were the widespread use of a secure clinical email service (Healthmail) that facilitates electronic prescription transfer and communication (75.3% of respondents) and the increased use of telephone consultations (49%). Overall, Healthmail was widely perceived to have had a positive impact on medication safety. Most GPs did not perceive a change in the frequency of medication safety incidents during the pandemic, while most pharmacists reported a slight increase in incidents. Survey participants highlighted pressure, patient expectations, and patient monitoring as significant challenges encountered during the pandemic. Conclusions During the pandemic, a number of significant changes occurred in primary care in Ireland, particularly involving communication of healthcare information, with varying impacts on workflow and medication safety. Future research should focus on the optimisation of electronic prescribing and telemedicine services in Ireland, patient perspectives on the changes in primary care, and interventions to improve medication safety in primary care.
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Affiliation(s)
- Laura L. Gleeson
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Aoife Ludlow
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Rob Argent
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Collins
- Research Unit, Irish College of General Practitioners, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Lisa Mellon
- Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - James W. Barlow
- Department of Chemistry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Benedict Ryan
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland
| | - Alice Holton
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Muriel Pate
- National Medication Safety Programme, National Quality and Patient Safety Directorate, Health Service Executive, Ireland
| | - Ciara Kirke
- National Medication Safety Programme, National Quality and Patient Safety Directorate, Health Service Executive, Ireland
| | - Michelle Flood
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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"Get Used to the Fact That Some of the Care Is Really Going to Take Place in a Different Way": General Practitioners' Experiences with E-Health during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095120. [PMID: 35564519 PMCID: PMC9104344 DOI: 10.3390/ijerph19095120] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/14/2022] [Accepted: 04/20/2022] [Indexed: 12/04/2022]
Abstract
The first outbreak of the COVID-19 pandemic led to the introduction of the more extensive use of e-health in Dutch general practices. The objective of this study was to investigate the experiences of general practitioners (GPs) regarding this change. In addition, the necessary conditions for e-health technology to be of added value to general practices were explored. In April 2020, 30 GPs were recruited for in-depth interviews via a web survey which contained questions regarding the use of e-health during the first wave of the pandemic. While most GPs intend to keep using e-health applications more extensively than before the pandemic, the actual use of e-health depends on several factors, including the characteristics of the application’s users. The following conditions for successful and sustainable implementation of e-health were identified: (1) integration of e-health technology in the organization of GP care, (2) sufficient user-friendliness of applications as well as digital skills of professionals and patients, and (3) adequate technological and financial support of e-health services. GPs clearly recognize the benefits of using e-health, and most GPs intend to keep using e-health applications more extensively than before the pandemic. However, improvements are needed to allow widespread and sustainable adoption of e-health technology in general practices.
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Early Nurse Management Experiences from Finnish COVID-19 Hubs: An In-Action Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084885. [PMID: 35457757 PMCID: PMC9031167 DOI: 10.3390/ijerph19084885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 02/01/2023]
Abstract
Primary healthcare (PHC) clinics are the point of access for many COVID-19 patients; however, the focus of crisis response work has been in securing hospital capacities. The purpose of this study was to describe the early nurse management experiences from PHC clinics within Greater Helsinki dedicated to caring for all ambulatory patients with possible COVID-19 symptoms. The study objectives were to make PHC crisis response contributions known and to provide an in-action review (IAR) of crisis response efforts. Nurse managers from the four COVID-19 hubs in Greater Helsinki were interviewed using thematic pair interviews. The data were analyzed inductively using thematic analysis, by which four main themes emerged: (1) capacity development led to a state of flux, (2) infection prevention control (IPC) was critical, (3) management of staff was essential in facilitating crisis response, and (4) respondents’ personal experiences. The state of flux stressed the provision of PHC services, but quick developments in telemedicine eased that burden. Conversation surrounding IPC was extensive, though discrepancies suggest that global efforts to standardize IPC practices must begin locally. Leadership was adjusted to accommodate for the crisis, especially regarding the motivation of staff. A vision to aspire toward in crisis recovery is needed.
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Stoffel ST, McGregor L, Hirst Y, Hanif S, Morris L, von Wagner C. Evaluation of the Call for a Kit intervention to increase bowel cancer screening uptake in Lancashire, England. J Med Screen 2022; 29:166-171. [PMID: 35410541 PMCID: PMC9381688 DOI: 10.1177/09691413221089184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the 'Call for a Kit' health promotion intervention that was initiated in Lancashire, England to improve bowel cancer screening uptake. METHODS Within the intervention, screening non-responders are called and invited to attend a consultation with a health promotion team member at their primary care practice. In this audit, we analysed the proportion of those contacted who attended the in-person clinic versus those who received a phone consultation, the number returning a test kit from in-person versus phone consultations, and the extent to which test kit return was moderated by sociodemographic characteristics. RESULTS In 2019, 68 practices participated in the intervention which led to 10,772 individuals being contacted; 2464 accepted the invitation to an in-person consultation, of whom 1943 attended. A further 1065 agreed to and attended a consultation over the phone. The 3008 consultations resulted in 2890 test kits being ordered, of which 1608 (55.6%) were returned. The intervention therefore yielded a 14.9% response rate in the total cohort; 71.5% of test kits came from individuals attending the in-person consultation. Women and those registered with a practice in socioeconomically deprived areas were less likely to return the test kit. Individuals with a black, mixed or a non-Indian/Pakistani Asian ethnic background were significantly more likely to accept the offer of an in-person consultation and return the test kit. CONCLUSION Our analysis demonstrated the strong likelihood of people returning a test kit after an in-person appointment but also the usefulness of using phone consultations as a safety net for people unable or unwilling to attend in-person clinics.
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Affiliation(s)
- Sandro T Stoffel
- Research Department of Behavioural Science and Health, University College London, London, UK.,Institute for Pharmaceutical Medicine, 27209University of Basel, Basel, Switzerland
| | - Lesley McGregor
- Division of Psychology, Faculty of Natural Sciences, 7622University of Stirling, Stirling, UK
| | - Yasemin Hirst
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Sahida Hanif
- 1756Blackpool Teaching Hospitals, NHS Foundation Trust, Blackpool, UK
| | - Lorraine Morris
- 1756Blackpool Teaching Hospitals, NHS Foundation Trust, Blackpool, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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Sabapathy T, Bansal R, Bojorquez L, Salley B, Gianakon JG, Gelineau-Morel R, Nyp SS. Missed Opportunities and the Impact of the Pandemic. J Dev Behav Pediatr 2022; 43:176-179. [PMID: 35085180 PMCID: PMC9203908 DOI: 10.1097/dbp.0000000000001065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CASE Benjamin is a 9-month-old, former 36-week gestation infant who presented to the high-risk infant follow-up clinic with parental concern for developmental regression. His mother reported that Benjamin seemed to be developing typically, but over the past 2 months, he has lost the ability to visually track objects, is not as engaged with her as he once was, and now only rarely makes babbling sounds. His mother also reported episodes of intermittent "bursts" of stiffening of his extremities and brief staring spells. Benjamin's mother described him as a "good, quiet baby." She commented that he used to laugh and cry more frequently but has recently been "very peaceful and calm." Benjamin's mother recently relayed her concerns for developmental regression to his pediatrician during an audio-only telehealth visit. Benjamin was referred to a pediatric neurologist, and the consultation visit is pending.His mother is a 28-year-old single parent whose pregnancy was complicated by pre-eclampsia, gestational diabetes, and anxiety. Benjamin required admission to the neonatal intensive care unit because of initial feeding difficulties. After 1 week, Benjamin was discharged to home and was referred for early intervention services. Owing to the pandemic, there were delays with initiating intervention, but bimonthly virtual interaction with a representative from the infant development program was eventually provided.Benjamin's mother expressed significant concerns regarding the potential of exposing him to a pandemic-related illness because of bringing her son to in-person medical visits. In fact, because of her concerns, she attended only virtual well-child pediatric visits over the past 6 months. A thorough social history revealed that she is a former dance studio instructor. The studio closed and she lost her primary source of income because of the pandemic. As a result, she decided to not send Benjamin to child care and maintained isolation from extended family members.On physical examination, pertinent findings included poor truncal tone, lack of orientation toward sounds, and limited eye contact. The Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) was administered, and the results indicated severe delays across all developmental areas, consistent with a diagnosis of global developmental delay.Benjamin's clinical presentation to the HRIF clinic and a history of developmental regression and intermittent body movements raised concerns for infantile spasms. He was transferred to the emergency department for evaluation and consideration for admission to the neurology service. An electroencephalogram confirmed epileptiform abnormalities consistent with infantile spasms, and he was immediately started on treatment.Impacts of the pandemic on the medical care of vulnerable/at-risk pediatric patients have included delayed receipt of early intervention services, parental fear regarding potential exposure to pandemic-related illness while seeking preventative care, increased use of virtual visit platforms for medical care and developmental intervention services, etc. What factors should be considered when providing support for these vulnerable/at-risk patients?
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Affiliation(s)
- Thusa Sabapathy
- The Center for Autism & Neurodevelopmental Disorders, University of California Irvine, Santa Ana, CA
| | | | | | - Brenda Salley
- Department of Pediatrics, University of Kansas Medical Center, Children's Mercy Kansas City, University of Kansas School of Medicine, Kansas City, KS
| | | | - Rose Gelineau-Morel
- Pediatric Neurology, University of Missouri-Kansas City, Division of Neurology, Children's Mercy Kansas City, Kansas City, MO
| | - Sarah S Nyp
- The Center for Autism & Neurodevelopmental Disorders, University of California Irvine, Santa Ana, CA
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Pulido-Fuentes M, Palmar-Santos AM, Flores-Martos JA, Cipriano-Crespo C, Rubio LA, González LA, Navarta-Sánchez MV. Internal dynamics within primary care teams in two Spanish regions during the COVID-19 pandemic: a qualitative study. BMC PRIMARY CARE 2022; 23:64. [PMID: 35361146 PMCID: PMC8970064 DOI: 10.1186/s12875-022-01674-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Pandemics and epidemics have represented public health emergencies with severe consequences at a global level. Primary care teams have played a crucial role in disease surveillance and monitoring during the COVID-19 pandemic through early detection, contact tracing, and isolation of positive cases. The objective of this study was to explore the impact of the COVID-19 pandemic on primary care teams regarding their internal dynamics and their professional performance. METHODS Qualitative study carried out between July and December 2020 in two large central and southern Spanish regions (Castilla la Mancha and Madrid). Semi-structured interviews and focus groups were conducted with primary care workers. Data was analysed using thematic content analysis. Participants were accessed using purposive sampling. RESULTS A total of 53 primary care workers participated in the study, of which 38 were individually interviewed, and 15 participated in three focus groups.The analysis of their experiences revealed two main themes regarding the impact of the COVID-19 pandemic on primary care teams: 1) The need to reorganise traditional roles: Primary care settings closed their doors to the public and their workers restructured their roles to ensure the delivery of essential services; 2) The need to implement a new primary care delivery model: Each primary care team had to self-organise, making sure their reference population was cared for and developing resource optimisation strategies. CONCLUSIONS Primary care teams have quickly adapted their roles and internal dynamics to respond to the demands generated by COVID-19. In the new delivery model, some positive aspects could be highlighted - such as increased communication between professionals and the use of telemedicine for some cases. However, it is important to address the negative impact that the COVID-19 crisis has had on of the main functions of primary care. These measures are necessary to promote well-being in primary care teams, and to provide quality care that addresses the complex and individual needs of each person and reduces inequalities in healthcare delivery.
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Affiliation(s)
- Montserrat Pulido-Fuentes
- Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de La Reina, Spain Avenida Real Fábrica de Sedas S/N, 45600 ToledoTalavera de la Reina, Toledo, Spain
| | - Ana María Palmar-Santos
- Departamento de Enfermería, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo nº 4, 28029 Madrid, Spain
| | | | - Carmen Cipriano-Crespo
- Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de La Reina, Spain Avenida Real Fábrica de Sedas S/N, 45600 ToledoTalavera de la Reina, Toledo, Spain
| | - Laura Alicia Rubio
- Departamento de Enfermería, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo nº 4, 28029 Madrid, Spain
| | - Luisa Abad González
- Faculty of Education Sciences and Humanities, University of Castilla -La Mancha, 16071 Cuenca, Spain
| | - MVictoria Navarta-Sánchez
- Departamento de Enfermería, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo nº 4, 28029 Madrid, Spain
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