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Plüss-Suard C, Mueller Y, Plate A, Senn O, Kronenberg A. Re: 'Impact of the COVID-19 pandemic on antibiotic prescribing in high-prescribing primary care physicians in Switzerland' by Aghlmandi et al. Clin Microbiol Infect 2024; 30:964-966. [PMID: 38467245 DOI: 10.1016/j.cmi.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/04/2024] [Indexed: 03/13/2024]
Affiliation(s)
- Catherine Plüss-Suard
- Swiss Centre for Antibiotic Resistance (ANRESIS), Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
| | - Yolanda Mueller
- Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Andreas Plate
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Andreas Kronenberg
- Swiss Centre for Antibiotic Resistance (ANRESIS), Institute for Infectious Diseases, University of Bern, Bern, Switzerland
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Aghlmandi S, Bielicki J, Bucher HC. 'Impact of the COVID-19 pandemic on antibiotic prescribing in high-prescribing primary care physicians in Switzerland' - Author's reply. Clin Microbiol Infect 2024; 30:967-968. [PMID: 38556211 DOI: 10.1016/j.cmi.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Soheila Aghlmandi
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland; Paediatric Research Center, University Children's Hospital Basel (UKBB), Basel, Switzerland.
| | - Julia Bielicki
- Infectious Diseases and Paediatric Research Centre University of Basel Children's Hospital and University of Basel, Basel, Switzerland; Centre for Neonatal and Paediatric Infection, St. George's University, London, UK
| | - Heiner C Bucher
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
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Reyes-Santias F, Reboredo-Nogueira JC, Garcia-Alvarez RM, Cinza-Sanjurjo S, Gonzalez Juanatey JR. Population-based disease-group analysis of Spanish excess mortality in the early COVID-19 pandemic period. Open Heart 2024; 11:e002568. [PMID: 38851247 PMCID: PMC11163686 DOI: 10.1136/openhrt-2023-002568] [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: 11/21/2023] [Accepted: 01/25/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND AND AIM Increased mortality during the COVID-19 pandemic is not explained exclusively by COVID-19 infection and its complications. We analysed non-COVID-19 causes of mortality in a population analysis based on data from the Spanish National Institute of Statistics. METHODS Using monthly mortality data in Spain (January 2010-December 2020), we analysed deaths associated with cancer, blood, endocrine, mental, nervous, cardiovascular, respiratory and digestive diseases and explored the COVID-19 impact using a difference-in-difference strategy. We calculated monthly interannual variations in mortality and computed percentage change in terms of the log of deaths in month h of year t minus the log of deaths in month h in the previous year t-1. RESULTS In 2020 in Spain, mortality increased 17.9% compared with 2019. COVID-19 was the leading cause of death (n=60 358), followed by ischaemic heart disease (n=29 654). Throughout 2020, monthly interannual variations in cardiovascular mortality showed an average upward trend of 1.7%, while digestive, cancer and blood diseases showed a downward trend. CONCLUSIONS During the COVID-19 pandemic in Spain in 2020, excess mortality was primarily related to cardiovascular mortality while mortality associated with digestive, cancer and blood diseases was reduced.
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Affiliation(s)
- Francisco Reyes-Santias
- University of Vigo, Vigo, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain
- IDIS, Santiago de Compostela, Spain
| | | | - Rosa Maria Garcia-Alvarez
- Preventive Medicine Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Sergio Cinza-Sanjurjo
- IDIS, Santiago de Compostela, Spain
- Primary Care, CS Milladoiro, SERGAS, Santiago de Compostela, Spain
| | - Jose Ramon Gonzalez Juanatey
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain
- IDIS, Santiago de Compostela, Spain
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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Chukwusa E, Barclay S, Gulliford M, Harding R, Higginson I, Verne J. General practice service use at the end-of-life before and during the COVID-19 pandemic: a population-based cohort study using primary care electronic health records. BJGP Open 2024; 8:BJGPO.2023.0108. [PMID: 37993135 PMCID: PMC11169988 DOI: 10.3399/bjgpo.2023.0108] [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: 06/09/2023] [Revised: 10/06/2023] [Accepted: 10/26/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Globally, the COVID-19 pandemic has caused unprecedented strain in healthcare systems, but little is known about how it affected patients requiring palliative and end-of-life care from GPs. AIM To evaluate the impact of the pandemic on primary care service use in the last 3 months of life, including consultations and prescribing, and to identify associated factors. DESIGN AND SETTING A retrospective cohort study in UK, using data from the Clinical Practice Research Datalink. METHOD The study cohort included those who died between 2019 and 2020. Poisson regression models using generalised estimation equations were used to examine the association between primary care use and patient characteristics. Adjusted rate ratios (aRRs) and 95% confidence intervals (95% CIs) were estimated. RESULTS A total of 44 534 patients died during the study period. The pandemic period was associated with an 8.9% increase in the rate of consultations from 966.4 to 1052.9 per 1000 person-months, and 14.3% longer telephone consultation duration (from 10.1 to 11.5 minutes), with a switch from face-to-face to telephone or video consultations. The prescription of end-of-life care medications increased by 6.3%, from 1313.7 to 1396.3 per 1000 person-months. The adjusted rate ratios for consultations (aRR = 1.08, 95% CI = 1.06 to 1.10, P<0.001) and prescriptions (aRR 1.05: 95% CI = 1.03 to 1.07, P<0.001) also increased during the pandemic. CONCLUSION The pandemic had a major impact on GP service use, leading to longer consultations, shifts from face-to-face to telephone or video consultations, and increased prescriptions. GP workload-related issues must be addressed urgently to ease the pressure on GPs.
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Affiliation(s)
- Emeka Chukwusa
- King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Martin Gulliford
- Department of Population Health Sciences, King's College London, Faculty of Life Science & Medicine, London, UK
| | - Richard Harding
- King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Irene Higginson
- King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
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Hoeks RA, Deml MJ, Dubois J, Senn O, Streit S, Rachamin Y, Jungo KT. Broken bones and apple brandy: resilience and sensemaking of general practitioners and their at-risk patients during the COVID-19 pandemic in Switzerland. Anthropol Med 2023; 30:346-361. [PMID: 38288956 PMCID: PMC10860889 DOI: 10.1080/13648470.2023.2269523] [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: 06/09/2023] [Accepted: 10/05/2023] [Indexed: 02/09/2024]
Abstract
In early 2020, when the first COVID-19 cases were confirmed in Switzerland, the federal government started implementing measures such as national stay-at-home recommendations and a strict limitation of health care services use. General practitioners (GPs) and their at-risk patients faced similar uncertainties and grappled with subsequent sensemaking of the unprecedented situation. Qualitative interviews with 24 GPs and 37 at-risk patients were conducted which were analyzed using thematic analysis. Weick's (1993) four sources of -resilience - improvisation, virtual role systems, attitudes of wisdom and respectful interaction - heuristically guide the exploration of on-the-ground experiences and informal ways GPs and their at-risk patients sought to ensure continuity of primary care. GPs used their metaphorical Swiss army knives of learned tools as well as existing knowledge and relationships to adapt to the extenuating circumstances. Through improvisation, GPs and patients found pragmatic solutions, such as using local farmer apple brandy as disinfectant or at-home treatments of clavicle fractures. Through virtual role systems, GPs and patients came to terms with new and shifting roles, such as "good soldier" and "at-risk patient" categorizations. Both parties adopted attitudes of wisdom by accepting that they could not know everything. They also diversified their sources of information through personal relationships, formal networks, and the internet. The GP-patient relationship grew in importance through respectful interaction, and intersubjective reflection helped make sense of shifting roles and ambiguous guidelines. The empirical analysis of this paper contributes to theoretical considerations of sensemaking, resilience, crisis settings and health systems.
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Affiliation(s)
- Rebekah A. Hoeks
- Institute of Social Anthropology, University of Basel, Basel, Switzerland
| | - Michael J. Deml
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - Julie Dubois
- Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Yael Rachamin
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Campus Stiftung Lindenhof Bern (SLB), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
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Barzegari J, Raeissi P, Hashemi SM, Aryan Khesal A, Reisi N. Delivering Primary Health Care (PHC) Services for Controlling NCDs During the COVID-19 Pandemic: A Scoping Review. JOURNAL OF PREVENTION (2022) 2023; 44:579-601. [PMID: 37495870 DOI: 10.1007/s10935-023-00733-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 07/28/2023]
Abstract
Non-communicable diseases (NCDs) are the leading cause of death worldwide. NCDs also increase mortality from COVID-19 and primary health care (PHC) services are an important component in the prevention and control of long-term NCDs. The main goal of the present study was to review primary healthcare services for the NCDs patients via primary healthcare network during COVID-19 pandemic. In this scoping review, Search engines including PubMed, Scopus, and Science-direct up to 1st February 2022 were searched to identify studies regarding primary care services for NCDs patients via primary health care during COVID-19 pandemic. A total of 42 studies met the inclusion criteria and were included in our analysis. 24 studies were about the status and changes of primary health services for NCDs patients in PHC settings, while 18 studies focused on adaptive strategies used during COVID-19 in different countries including United States, Canada, United Kingdom, Portugal, Georgia, South Africa, Thailand, Mexico, India, Kenya, Guatemala and Saudi Arabia. These strategies included remote monitoring, follow up, consultation, empowerment and educational services as well as home visiting Disruption of NCDs services in PHC during the COVID-19 pandemic was observed in different countries, which highlights the urgency of attention of researchers and policy-makers to development of appropriate and adaptive policies to improve PHC service coverage and its quality during the pandemics.
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Affiliation(s)
- Javad Barzegari
- Department of Health Services Management, School of Health Services Management and Medical Information Science, Iran University of Medical Sciences, No. 6, Rashid Yasemi St. Vali -e Asr Ave, P.O Box: 1996713883, Tehran, Iran
| | - Pouran Raeissi
- Department of Health Services Management, School of Health Services Management and Medical Information Science, Iran University of Medical Sciences, No. 6, Rashid Yasemi St. Vali -e Asr Ave, P.O Box: 1996713883, Tehran, Iran.
| | - Seyed- Masoud Hashemi
- Department of Anesthesiology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aidin Aryan Khesal
- Department of Health Services Management, School of Health Services Management and Medical Information Science, Iran University of Medical Sciences, No. 6, Rashid Yasemi St. Vali -e Asr Ave, P.O Box: 1996713883, Tehran, Iran
| | - Nahid Reisi
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Child Growth and Development Research Center and Isfahan Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Harju E, Speierer A, Jungo KT, Levati S, Baggio S, Tancredi S, Noor N, Rodondi PY, Cullati S, Imboden M, Keidel D, Witzig M, Frank I, Kohler P, Kahlert C, Crivelli L, Amati R, Albanese E, Kaufmann M, Frei A, von Wyl V, Puhan MA, Probst-Hensch N, Michel G, Rodondi N, Chocano-Bedoya P. Changes in Healthcare Utilization During the COVID-19 Pandemic and Potential Causes-A Cohort Study From Switzerland. Int J Public Health 2023; 68:1606010. [PMID: 37663371 PMCID: PMC10469983 DOI: 10.3389/ijph.2023.1606010] [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: 03/22/2023] [Accepted: 07/05/2023] [Indexed: 09/05/2023] Open
Abstract
Objectives: To describe the frequency of and reasons for changes in healthcare utilization in those requiring ongoing treatment, and to assess characteristics associated with change, during the second wave of the pandemic. Methods: Corona Immunitas e-cohort study (age ≥20 years) participants completed monthly questionnaires. We compared participants reporting a change in healthcare utilization with those who did not using descriptive and bivariate statistics. We explored characteristics associated with the number of changes using negative binomial regression. Results: The study included 3,190 participants from nine research sites. One-fifth reported requiring regular treatment. Among these, 14% reported a change in healthcare utilization, defined as events in which participants reported that they changed their ongoing treatment, irrespective of the reason. Reasons for change were medication changes and side-effects, specifically for hypertension, or pulmonary embolism treatment. Females were more likely to report changes [Incidence Rate Ratio (IRR) = 2.15, p = 0.002]. Those with hypertension were least likely to report changes [IRR = 0.35, p = 0.019]. Conclusion: Few of those requiring regular treatment reported changes in healthcare utilization. Continuity of care for females and chronic diseases besides hypertension must be emphasized.
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Affiliation(s)
- Erika Harju
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
- Clinical Trial Unit, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Alexandre Speierer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Sara Levati
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory (#PopHealthLab), Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Stefano Tancredi
- Population Health Laboratory (#PopHealthLab), Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Nazihah Noor
- Population Health Laboratory (#PopHealthLab), Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | | | - Stéphane Cullati
- Population Health Laboratory (#PopHealthLab), Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Quality of Care Service, Geneva University Hospitals, Geneva, Switzerland
| | - Medea Imboden
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland
- Department of Public Health, University of Basel, Basel, Switzerland
| | - Dirk Keidel
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland
- Department of Public Health, University of Basel, Basel, Switzerland
| | - Melissa Witzig
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland
- Department of Public Health, University of Basel, Basel, Switzerland
| | - Irène Frank
- Clinical Trial Unit, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Philipp Kohler
- Department of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christian Kahlert
- Department of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Infectious Diseases and Hospital Epidemiology, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Luca Crivelli
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Rebecca Amati
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Emiliano Albanese
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Marco Kaufmann
- Epidemiology, Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zürich, Switzerland
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland
- Department of Public Health, University of Basel, Basel, Switzerland
| | - Gisela Michel
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patricia Chocano-Bedoya
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory (#PopHealthLab), Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
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Mazón-Ramos P, Román-Rego A, Díaz-Fernández B, Portela-Romero M, Garcia-Vega D, Bastos-Fernández M, Rey-Aldana D, Lage-Fernández R, Cinza-Sanjurjo S, González-Juanatey JR. Impact of the COVID-19 pandemic upon a universal electronic consultation program (e-consultation) between general practitioners and cardiologists. Rev Clin Esp 2023; 223:350-358. [PMID: 37146749 PMCID: PMC10154244 DOI: 10.1016/j.rceng.2023.04.010] [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: 09/25/2022] [Accepted: 03/11/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are no data corresponding to models between clinicians. An analysis was made of the impact of the COVID-19 pandemic upon the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our healthcare area. METHODS Patients with at least one e-consultation between 2018 and 2021 were selected. We analyzed the impact of the COVID-19 pandemic upon activity and waiting time for care, hospitalizations and mortality, taking as reference the consultations carried out during 2018. RESULTS A total of 25,121 patients were analyzed. Logistic regression analysis showed a shorter delay in care and resolution of the e-consultation without the need for face-to-face care to be associated to a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated to poorer health outcomes compared to 2018. CONCLUSIONS The results of our study show a significant reduction in e-consultation referrals during the first year of the COVID-19 pandemic, with a subsequent recovery in the demand for care, and without the pandemic periods being associated to poorer outcomes. The reduction in time elapsed for resolving the e-consultations and no need for face-to-face visits were associated to improved outcomes.
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Affiliation(s)
- P Mazón-Ramos
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - A Román-Rego
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - B Díaz-Fernández
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - M Portela-Romero
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Concepción Arenal Primary Care Center, Área Sanitaria Integrada Santiago de Compostela, Santiago de Compostela, Spain
| | - D Garcia-Vega
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - M Bastos-Fernández
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - D Rey-Aldana
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; A Estrada Primary Care Center, Área Sanitaria Integrada Santiago de Compostela, Pontevedra, Spain
| | - R Lage-Fernández
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - S Cinza-Sanjurjo
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Milladoiro Primary Care Center, Área Sanitaria Integrada Santiago de Compostela, Ames, Spain.
| | - J R González-Juanatey
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Holland D, Heald AH, Hanna FFW, Stedman M, Wu P, Sim J, Duff CJ, Duce H, Green L, Scargill J, Howe JD, Robinson S, Halsall I, Gaskell N, Davison A, Simms M, Denny A, Langan M, Fryer AA. The Effect of the COVID-19 Pandemic on HbA1c Testing: Prioritization of High-Risk Cases and Impact of Social Deprivation. Diabetes Ther 2023; 14:691-707. [PMID: 36814045 PMCID: PMC9946287 DOI: 10.1007/s13300-023-01380-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/07/2023] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Studies show that the COVID-19 pandemic disproportionately affected people with diabetes and those from disadvantaged backgrounds. During the first 6 months of the UK lockdown, > 6.6 M glycated haemoglobin (HbA1c) tests were missed. We now report variability in the recovery of HbA1c testing, and its association with diabetes control and demographic characteristics. METHODS In a service evaluation, we examined HbA1c testing across ten UK sites (representing 9.9% of England's population) from January 2019 to December 2021. We compared monthly requests from April 2020 to those in the equivalent 2019 months. We examined effects of (i) HbA1c level, (ii) between-practice variability, and (iii) practice demographics. RESULTS In April 2020, monthly requests dropped to 7.9-18.1% of 2019 volumes. By July 2020, testing had recovered to 61.7-86.9% of 2019 levels. During April-June 2020, we observed a 5.1-fold variation in the reduction of HbA1c testing between general practices (12.4-63.8% of 2019 levels). There was evidence of limited prioritization of testing for patients with HbA1c > 86 mmol/mol during April-June 2020 (4.6% of total tests vs. 2.6% during 2019). Testing in areas with the highest social disadvantage was lower during the first lockdown (April-June 2020; trend test p < 0.001) and two subsequent periods (July-September and October-December 2020; both p < 0.001). By February 2021, testing in the highest deprivation group had a cumulative fall in testing of 34.9% of 2019 levels versus 24.6% in those in the lowest group. CONCLUSION Our findings highlight that the pandemic response had a major impact on diabetes monitoring and screening. Despite limited test prioritization in the > 86 mmol/mol group, this failed to acknowledge that those in the 59-86 mmol/mol group require consistent monitoring to achieve the best outcomes. Our findings provide additional evidence that those from poorer backgrounds were disproportionately disadvantaged. Healthcare services should redress this health inequality.
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Affiliation(s)
| | - Adrian H Heald
- Department of Diabetes and Endocrinology, Salford Royal Hospital, The Northern Care Alliance NHS Foundation Trust, Salford, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Fahmy F W Hanna
- Department of Diabetes and Endocrinology, University Hospitals of North Midlands NHS Trust, Stoke-On-Trent, Staffordshire, UK
- Centre for Health & Development, Staffordshire University, Staffordshire, UK
| | | | - Pensée Wu
- Department of Obstetrics & Gynaecology, University Hospitals of North Midlands NHS Trust, Stoke-On-Trent, Staffordshire, UK
- School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Julius Sim
- School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Christopher J Duff
- School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
- Department of Clinical Biochemistry, North Midlands and Cheshire Pathology Services, University Hospitals of North Midlands NHS Trust, Stoke-On-Trent, Staffordshire, UK
| | - Helen Duce
- Department of Clinical Biochemistry, North Midlands and Cheshire Pathology Services, University Hospitals of North Midlands NHS Trust, Stoke-On-Trent, Staffordshire, UK
| | - Lewis Green
- Department of Clinical Biochemistry, St. Helens & Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, UK
| | - Jonathan Scargill
- Department of Clinical Biochemistry, The Royal Oldham Hospital, The Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - Jonathon D Howe
- Department of Clinical Biochemistry, Salford Royal Hospital, The Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - Sarah Robinson
- Department of Clinical Biochemistry, North Midlands and Cheshire Pathology Services, University Hospitals of North Midlands NHS Trust, Stoke-On-Trent, Staffordshire, UK
| | - Ian Halsall
- Department of Clinical Biochemistry, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Neil Gaskell
- Department of Pathology, Warrington & Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
| | - Andrew Davison
- Department of Clinical Biochemistry & Metabolic Medicine, Liverpool Clinical Laboratories, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Mark Simms
- Department of Clinical Biochemistry, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, Wirral, UK
| | - Angela Denny
- Department of Clinical Biochemistry, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, Wirral, UK
| | - Martin Langan
- Pathology Directorate, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Anthony A Fryer
- School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK.
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10
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Vandamme J, Beerten SG, Crèvecoeur J, Van den Bulck S, Aertgeerts B, Delvaux N, Van Pottelbergh G, Vermandere M, Tops L, Neyens T, Vaes B. The Impact of the COVID-19 Pandemic on the Registration and Care Provision of Mental Health Problems in General Practice: Registry-Based Study. JMIR Public Health Surveill 2023; 9:e43049. [PMID: 36599160 PMCID: PMC10039400 DOI: 10.2196/43049] [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: 09/28/2022] [Revised: 11/17/2022] [Accepted: 12/16/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The impact of the COVID-19 pandemic on mental health in general practice remains uncertain. Several studies showed an increase in terms of mental health problems during the pandemic. In Belgium, especially during the first waves of the pandemic, access to general practice was limited. Specifically, it is unclear how this impacted not only the registration of mental health problems itself but also the care for patients with an existing mental health problem. OBJECTIVE This study aimed to know the impact of the COVID-19 pandemic on (1) the incidence of newly registered mental health problems and (2) the provision of care for patients with mental health problems in general practice, both using a pre-COVID-19 baseline. METHODS The prepandemic volume of provided care (care provision) for patients with mental health problems was compared to that from 2020-2021 by using INTEGO, a Belgian general practice morbidity registry. Care provision was defined as the total number of new registrations in a patient's electronic medical record. Regression models evaluated the association of demographic factors and care provision in patients with mental health problems, both before and during the pandemic. RESULTS During the COVID-19 pandemic as compared to before the COVID-19 pandemic, the incidence of registered mental health problems showed a fluctuating course, with a sharp drop in registrations during the first wave. Registrations for depression and anxiety increased, whereas the incidence of registered eating disorders, substance abuse, and personality problems decreased. During the 5 COVID-19 waves, the overall incidence of registered mental health problems dropped during the wave and rose again when measures were relaxed. A relative rise of 8.7% and 40% in volume of provided care, specifically for patients with mental health problems, was seen during the first and second years of the COVID-19 pandemic, respectively. Care provision for patients with mental health problems was higher in older patients, male patients, patients living in center cities (centrumsteden), patients with lower socioeconomic status (SES), native Belgian patients, and patients with acute rather than chronic mental health problems. Compared to prepandemic care provision, a reduction of 10% was observed in people with a low SES. CONCLUSIONS This study showed (1) a relative overall increase in the registrations of mental health problems in general practice and (2) an increase in care provision for patients with mental health problems in the first 2 years of the COVID-19 pandemic. Low SES remained a determining factor for more care provision, but care provision dropped significantly in people with mental health problems with a low SES. Our findings suggest that the pandemic in Belgium was also largely a "syndemic," affecting different layers of the population disproportionately.
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Affiliation(s)
- Jan Vandamme
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Simon Gabriël Beerten
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jonas Crèvecoeur
- Leuven Biostatistics and Statistical Bioinformatics Centre, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Data Science Institute, UHasselt, Hasselt, Belgium
| | - Steve Van den Bulck
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Bert Aertgeerts
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Nicolas Delvaux
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Gijs Van Pottelbergh
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Mieke Vermandere
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Laura Tops
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Thomas Neyens
- Leuven Biostatistics and Statistical Bioinformatics Centre, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Data Science Institute, UHasselt, Hasselt, Belgium
| | - Bert Vaes
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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11
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Cebrino J, Portero de la Cruz S. Polypharmacy and associated factors: a gender perspective in the elderly Spanish population (2011-2020). Front Pharmacol 2023; 14:1189644. [PMID: 37153776 PMCID: PMC10160439 DOI: 10.3389/fphar.2023.1189644] [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] [Received: 03/19/2023] [Accepted: 04/14/2023] [Indexed: 05/10/2023] Open
Abstract
Background: Few studies have examined the epidemiology of polypharmacy in non-institutionalized elderly adults with regard to sex differences. This study aimed to identify the prevalence of polypharmacy among people ≥65 years old residing in Spain, analyze trends in that prevalence from 2011/12 to 2020, describe the use of the medicines involved and study the possible relationship between polypharmacy and certain sociodemographic, health-related variables, as well as the use of care services by sex. Methods: A nationwide cross-sectional study with 21,841 non-institutionalized people ≥65 years old from the Spanish National Health Survey (2011/2012 and 2017) and the European Health Survey in Spain (2014 and 2020) was performed. We used descriptive statistics, performing two binary logistic regressions to determine the factors related to polypharmacy. Results: The prevalence of polypharmacy was 23.2% (women: 28.1%, men: 17.2%; p < 0.001). The most commonly consumed medicines were analgesics and tranquillizers, relaxants or sleeping pills in elderly women, compared with antihypertensives, antacids and antiulcer drugs and statins for elderly men. In both sexs, the positive predictors of polypharmacy included average, poor and very poor self-perceived states of health, people with overweight and obesity, being severely/non-severely limited due to a health problem, having ≥ three chronic conditions, visits to the family doctor and hospitalization. Among elderly women, negative predictors were alcohol intake, whereas in elderly men positive predictors were being 75-84 years old, being current smokers and having 1, 2 chronic conditions. Conclusion: Polypharmacy has a prevalence of 23.2%, with women accounting for 28.1% and men 17.2% of the total. Knowledge of positive and negative predictors of polypharmacy have important implications for public health efforts to develop or improve health guidelines and strategies for promoting the proper use of medication, particularly in the elderly population by sex.
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Affiliation(s)
- Jesús Cebrino
- Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - Silvia Portero de la Cruz
- Department of Nursing, Pharmacology and Physiotherapy, University of Córdoba, Córdoba, Spain
- Research Group GC12 Clinical and Epidemiological Research in Primary Care, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
- *Correspondence: Silvia Portero de la Cruz,
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12
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Kim JH, Ahn C, Namgung M. Epidemiology and Outcome of Out-of-Hospital Cardiac Arrests during the COVID-19 Pandemic in South Korea: A Systematic Review and Meta-Analyses. Yonsei Med J 2022; 63:1121-1129. [PMID: 36444548 PMCID: PMC9760885 DOI: 10.3349/ymj.2022.0339] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/04/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the effect of coronavirus disease 2019 (COVID-19) on out-of-hospital cardiac arrest (OHCA) outcomes in South Korea, we conducted systematic review and meta-analysis. MATERIALS AND METHODS MEDLINE, Embase, KoreaMed, and Korean Information Service System databases were searched up to June 2022. We included observational studies and letters on OHCA during the COVID-19 pandemic and compared them to those before the pandemic. Epidemiologic characteristics, including at-home OHCA, bystander cardiopulmonary resuscitation, unwitnessed arrest, use of an automated external defibrillator (AED), shockable cardiac rhythm, and airway management, were evaluated. Survival and favorable neurological outcomes were extracted. We conducted a meta-analysis of each characteristic and outcome. RESULTS Six studies including 4628 OHCA patients were included in this study. The incidence of at-home OHCA significantly increased and the AED use decreased during the COVID-19 pandemic compared to before the pandemic [odds ratio (OR), 1.29; 95% confidence interval (CI), 1.08-1.55; I²=0% and OR, 0.74; 95% CI, 0.57-0.97; I²=0%, respectively]. Return of spontaneous circulation after OHCA, survival, and favorable neurological outcomes during and before the pandemic did not differ significantly (OR, 0.90; 95% CI, 0.71-1.13; I²=37%; OR, 0.74; 95% CI, 0.43-1.26; I²=72%; OR, 0.77; 95% CI, 0.43-1.37; I²=70%, respectively). CONCLUSION During the COVID-19 pandemic in South Korea, the incidence of at-home OHCA increased and AED use decreased among OHCA patients. However, survival and favorable neurological outcomes did not significantly differ from before the pandemic. This insignificant effect of the pandemic on OHCA in South Korea could be attributed to the slow increase in patient count in the early days of the pandemic. OSF Registry (DOI: 10.17605/OSF.IO/UGE9D).
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Affiliation(s)
- Jae Hwan Kim
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Korea.
| | - Myeong Namgung
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
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13
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Rachamin Y, Meyer MR, Rosemann T, Grischott T. Impact of the COVID-19 Pandemic on Elective and Emergency Inpatient Procedure Volumes in Switzerland - A Retrospective Study Based on Insurance Claims Data. Int J Health Policy Manag 2022; 12:6932. [PMID: 36243943 PMCID: PMC10125178 DOI: 10.34172/ijhpm.2022.6932] [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: 11/10/2021] [Accepted: 08/14/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) pandemic forced hospitals to redistribute resources for the treatment of patients with coronavirus disease 2019 (COVID-19), yet the impact on elective and emergency inpatient procedure volumes is unclear. METHODS We analyzed anonymized data on 234 921 hospitalizations in 2017-2020 (55.9% elective) from a big Swiss health insurer. We used linear regression models to predict, based on pre-pandemic data, the expected weekly numbers of procedures in 2020 in the absence of a pandemic and compared these to the observed numbers in 2020. Compensation effects were investigated by discretely integrating the difference between the two numbers over time. RESULTS During the first COVID-19 wave in spring 2020, elective procedure numbers decreased by 52.9% (95% confidence interval -64.5% to -42.5%), with cardiovascular and orthopedic elective procedure numbers specifically decreasing by 45.5% and 72.4%. Elective procedure numbers normalized during summer with some compensation of postponed procedures, leaving a deficit of -9.9% (-15.8% to -4.5%) for the whole year 2020. Emergency procedure numbers also decreased by 17.1% (-23.7% to -9.8%) during the first wave, but over the whole year 2020, net emergency procedure volumes were similar to control years. CONCLUSION Inpatient procedure volumes in Switzerland decreased considerably in the beginning of the pandemic but recovered quickly after the first wave. Still, there was a net deficit in procedures at the end of the year. Health system leaders must work to ensure that adequate access to non-COVID-19 related care is maintained during future pandemic phases in order to prevent negative health consequences.
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Affiliation(s)
- Yael Rachamin
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Matthias R. Meyer
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Division of Cardiology, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Thomas Grischott
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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14
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Di Gangi S, Lüthi B, Diaz Hernandez L, Zeller A, Zechmann S, Fischer R. Quality outcome of diabetes care during COVID-19 pandemic: a primary care cohort study. Acta Diabetol 2022; 59:1189-1200. [PMID: 35780277 PMCID: PMC9329414 DOI: 10.1007/s00592-022-01920-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/08/2022] [Indexed: 11/14/2022]
Abstract
AIM Management of diabetes care can be affected by COVID-19 pandemic control measures. This study aimed to determine the impact of the pandemic, during 17.03.2020-16.03.2021, on quality outcomes of diabetes care in general practice in Switzerland. METHODS In this retrospective cohort study, diabetes mellitus patients (≥ 18 years) with at least one consultation at a general practitioner, during 17.03.2018-16.03.2019 (cohort 1) and 17.03.2019-16.03.2020 (cohort 2) were included and followed-up for two years. Quality indicators and outcomes of diabetes care, at patient and practitioner level, were compared before and during the pandemic. Logistic regression was performed to identify patient's risk factors for dropout from follow-up. RESULTS Data from 191 practices, 23,903 patients, cohort 1 and 25,092 patients, cohort 2, were analyzed. The fraction of patients lost to follow-up, attributable to the pandemic, was 28% (95% confidence interval: 25%, 30%). During the pandemic, compared to the previous year, regular measurement of weight, HbA1c, blood pressure and serum creatinine were less frequent and less patients per practitioner reached HbA1c and blood pressure target outcomes. Factors associated with continuity of care during the pandemic were: patient age 41-80 years, longer diabetes duration, diagnosis of hypertension or dyslipidemia, influenza vaccination during the last year. Risk factors for dropout were age > 80 and receiving only insulin as anti-diabetic medication. CONCLUSION A considerable quality reduction in diabetes mellitus care could be observed during the pandemic. Though the most vulnerable patients were not the most affected by the pandemic, key factors that might reduce dropout from follow-up were identified.
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Affiliation(s)
- Stefania Di Gangi
- Institute of Primary Care, University and University Hospital Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland
| | - Benjamin Lüthi
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | | | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Stefan Zechmann
- Institute of Primary Care, University and University Hospital Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
| | - Roland Fischer
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
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15
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Nadarajah R, Wu J, Hurdus B, Asma S, Bhatt DL, Biondi-Zoccai G, Mehta LS, Ram CVS, Ribeiro ALP, Van Spall HG, Deanfield JE, Lüscher TF, Mamas M, Gale CP. The collateral damage of COVID-19 to cardiovascular services: a meta-analysis. Eur Heart J 2022; 43:3164-3178. [PMID: 36044988 PMCID: PMC9724453 DOI: 10.1093/eurheartj/ehac227] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/02/2022] [Accepted: 04/20/2022] [Indexed: 07/21/2023] Open
Abstract
AIMS The effect of the COVID-19 pandemic on care and outcomes across non-COVID-19 cardiovascular (CV) diseases is unknown. A systematic review and meta-analysis was performed to quantify the effect and investigate for variation by CV disease, geographic region, country income classification and the time course of the pandemic. METHODS AND RESULTS From January 2019 to December 2021, Medline and Embase databases were searched for observational studies comparing a pandemic and pre-pandemic period with relation to CV disease hospitalisations, diagnostic and interventional procedures, outpatient consultations, and mortality. Observational data were synthesised by incidence rate ratios (IRR) and risk ratios (RR) for binary outcomes and weighted mean differences for continuous outcomes with 95% confidence intervals. The study was registered with PROSPERO (CRD42021265930). A total of 158 studies, covering 49 countries and 6 continents, were used for quantitative synthesis. Most studies (80%) reported information for high-income countries (HICs). Across all CV disease and geographies there were fewer hospitalisations, diagnostic and interventional procedures, and outpatient consultations during the pandemic. By meta-regression, in low-middle income countries (LMICs) compared to HICs the decline in ST-segment elevation myocardial infarction (STEMI) hospitalisations (RR 0.79, 95% confidence interval [CI] 0.66-0.94) and revascularisation (RR 0.73, 95% CI 0.62-0.87) was more severe. In LMICs, but not HICs, in-hospital mortality increased for STEMI (RR 1.22, 95% CI 1.10-1.37) and heart failure (RR 1.08, 95% CI 1.04-1.12). The magnitude of decline in hospitalisations for CV diseases did not differ between the first and second wave. CONCLUSIONS There was substantial global collateral CV damage during the COVID-19 pandemic with disparity in severity by country income classification.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, Leeds LS2 9DA, UK
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jianhua Wu
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- School of Dentistry, University of Leeds, Leeds, UK
| | - Ben Hurdus
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Samira Asma
- Division of Data, Analytics and Delivery for Impact, World Health Organization, Geneva, Switzerland
| | - Deepak L. Bhatt
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Laxmi S. Mehta
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - C. Venkata S. Ram
- Apollo Hospitals and Medical College, Hyderabad, Telangana, India
- University of Texas Southwestern Medical School, Dallas, TX, USA
- Faculty of Medical and Health Sciences, Macquarie University, Sydney, Australia
| | - Antonio Luiz P. Ribeiro
- Cardiology Service and Telehealth Center, Hospital das Clínicas, and Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Harriette G.C. Van Spall
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Population Health Research Institute, Hamilton, Canada
| | - John E. Deanfield
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Sciences, University College, London, UK
| | - Thomas F. Lüscher
- Imperial College, National Heart and Lung Institute, London, UK
- Royal Brompton & Harefield Hospital, Imperial College, London, UK
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Institute for Prognosis Research, University of Keele, Keele, UK
| | - Chris P. Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, Leeds LS2 9DA, UK
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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16
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Deml MJ, Minnema J, Dubois J, Senn O, Streit S, Rachamin Y, Jungo KT. The impact of the COVID-19 pandemic on the continuity of care for at-risk patients in Swiss primary care settings: A mixed-methods study. Soc Sci Med 2022; 298:114858. [PMID: 35247784 PMCID: PMC8868005 DOI: 10.1016/j.socscimed.2022.114858] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 02/07/2023]
Abstract
Continuity of care is important for the health of aging individuals with comorbidities. When initial coronavirus mitigation campaigns involved messaging such as "Stay at home-stay safe," and banned provision of non-urgent care, at-risk patients depending upon regular consultations with general practitioners (GPs) faced confusion about the possibility of seeking non-COVID-19 related healthcare. We employed a sequential explanatory mixed-methods design, consisting of a quantitative component followed by a qualitative component, to understand at-risk patients' health services use during the COVID-19 pandemic in Switzerland. Quantitatively, we used electronic medical records data from 272 GPs and 266,796 patients. Based on pre-pandemic data, we predicted weekly consultation counts as well as weekly measurement counts (blood pressure, glycated hemoglobin, and low-density lipoprotein cholesterol) per 100 patients that would be expected in 2020 in absence of a pandemic and compared those to actual observed values. Qualitatively, we conducted 23 semi-structured interviews with 24 GPs (∼45 min) and 37 interviews with at-risk patients (∼35 min). Quantitative results demonstrate a significant decrease in consultation and measurement counts during the first shutdown period, with consultation counts quickly returning to normal and moving within expected values for the rest of 2020. Qualitative data contextualize these findings with GPs describing constantly implementing material, administrative, and communication changes. GPs reported communication gaps with the authorities and noted a lack of clear guidelines delineating how to define "at-risk patients" and what cases were "urgent" to treat during shutdowns. Patient interviews show that patient-level factors, such as fear of contracting coronavirus, perceptions that GPs were overburdened, and a sense of solidarity, influenced patients' decisions to consult less at the beginning of the pandemic. Findings demonstrate communication gaps during pandemic periods and provide valuable lessons for future pandemic preparedness, particularly the need for contingency plans for the overall healthcare system instead of plans focusing only on the infectious agent itself.
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Affiliation(s)
- Michael J Deml
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland; Division of Social and Behavioural Sciences, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Julia Minnema
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Julie Dubois
- Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Yael Rachamin
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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Infant, pediatric and adult well visit trends before and during the COVID-19 pandemic: a retrospective cohort study. BMC Health Serv Res 2022; 22:328. [PMID: 35277169 PMCID: PMC8916698 DOI: 10.1186/s12913-022-07719-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background Adult well visits declined during COVID-19, but literature is inconsistent in regard to whether childhood well visits declined. We determined if the COVID-19 pandemic was associated with a change in well visits among infants, children, adolescents and adults before, compared to during the COVID-19 pandemic, including through the emergence of the Delta variant. Methods De-identified electronic health care data came from a multi-state Midwest health care system. Eligible patients (n = 798,571) had ≥ 1 well visit between 7/1/2018 and 6/30/2021. Trends in well visits per month for children (< 1, 1–4, 5–11, 12–17 years) and adults (18–39, 40–64, ≥ 65 years) over 3-years were assessed using Joinpoint regression models and monthly percent change (MPC). Results Well visits remained stable for infants (< 1 year of age) (MPC = -0.1; 95% CI = -0.3, 0.1). For children 1–4 years and all adults, visits were stable prior to 2020, decreased from 1/2020 to 4/2020 (MPC range -20 to -40), increased from 4/2020–7/2020 (MPC range 30 to 72), and remained stable after 7/2020. Children 5–17 had seasonal variation in visits where low points occurred in Jan/Feb 2019 and high points in Aug 2019 (start of school year); however, the low point in 2020 occurred in April 2020 and the seasonal variation normalized after this. Conclusions In a large Mid-western health care system, infant well visits did not decline at the onset (3/1/2020) of the COVID-19 pandemic. Although well visits for all other ages decreased to a low point in 4/2020, a rapid return to pre-pandemic utilization rates occurred by 7/2020. The brief decrease in preventive care may have had little impact on health. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07719-7.
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Maehl N, Bleckwenn M, Riedel-Heller SG, Mehlhorn S, Lippmann S, Deutsch T, Schrimpf A. The Impact of the COVID-19 Pandemic on Avoidance of Health Care, Symptom Severity, and Mental Well-Being in Patients With Coronary Artery Disease. Front Med (Lausanne) 2022; 8:760265. [PMID: 34977066 PMCID: PMC8714893 DOI: 10.3389/fmed.2021.760265] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/10/2021] [Indexed: 12/27/2022] Open
Abstract
The COVID-19 pandemic affected regular health care for patients with chronic diseases. However, the impact of the pandemic on primary care for patients with coronary artery disease (CAD) who are enrolled in a structured disease management program (DMP) in Germany is not clear. We investigated whether the pandemic affected primary care and health outcomes of DMP-CAD patients (n = 750) by using a questionnaire assessing patients' utilization of medical care, CAD symptoms, as well as health behavior and mental health since March 2020. We found that out of concern about getting infected with COVID-19, 9.1% of the patients did not consult a medical practitioner despite having CAD symptoms. Perceived own influence on infection risk was lower and anxiety was higher in these patients compared to symptomatic CAD patients who consulted a physician. Among the patients who reported chest pain lasting longer than 30 min, one third did not consult a medical practitioner subsequently. These patients were generally more worried about COVID-19. Patients with at least one worsening CAD symptom (chest pain, dyspnea, perspiration, or nausea without apparent reason) since the pandemic showed more depressive symptoms, higher anxiety scores, and were less likely to consult a doctor despite having CAD symptoms out of fear of infection. Our results provide evidence that the majority of patients received sufficient medical care during the COVID-19 pandemic in Germany. However, one in ten patients could be considered particularly at risk for medical undersupply and adverse health outcomes. The perceived infection risk with COVID-19 might have facilitated the decision not to consult a medical doctor.
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Affiliation(s)
- Nathalie Maehl
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Markus Bleckwenn
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Leipzig University, Leipzig, Germany
| | | | - Stefan Lippmann
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Tobias Deutsch
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Anne Schrimpf
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
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