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Willems S, Vanden Bussche P, Van Poel E, Collins C, Klemenc-Ketis Z. Moving forward after the COVID-19 pandemic: Lessons learned in primary care from the multi-country PRICOV-19 study. Eur J Gen Pract 2024; 30:2328716. [PMID: 38511848 PMCID: PMC10984223 DOI: 10.1080/13814788.2024.2328716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/20/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has accentuated the indispensable role of primary care. Objectives: Recognising this, the PRICOV-19 study investigated how 5,489 GP practices across 38 countries (Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Kosovo*, Latvia, Lithuania, Luxembourg, Malta, Republic of Moldova, Netherlands, North Macedonia, Norway, Poland, Portugal, Romania, Serbia, Slovenia, Spain, Sweden, Switzerland, Turkey, Ukraine, and United Kingdom) adapted their care delivery during the pandemic. METHODS Based on a series of discussions on the results of the PRICOV-19 study group, eight recommendations to enhance primary care's preparedness for future crises were formulated and endorsed by EQuiP and WONCA Europe. RESULTS The recommendations underscore the importance of recognising and sustaining the substantial strides made in patient safety within GP practices during the pandemic in current daily practices; acknowledging and supporting the pivotal role of GP practices in addressing health inequalities during crises; adopting interprofessional care models to enhance practices' resilience and adaptability to change; supporting training practices; creating healthy working environments; investing in infrastructure that supports adequate and safe care; and increasing funding for research on patient safety and primary care quality to inform evidence-based health policies and fostering international knowledge exchange among healthcare professionals and policymakers. CONCLUSION Policymakers, primary care associations, and the broader healthcare system are urged to collaboratively take responsibility and increase support for GP practices to enhance their resilience, adaptability, and capacity to deliver safe and equitable healthcare during future crises.
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Affiliation(s)
- Sara Willems
- Equity Research Group, 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
- European Association for Quality and Patient Safety in General Practice/Family Medicine
| | - Pierre Vanden Bussche
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- European Association for Quality and Patient Safety in General Practice/Family Medicine
- Academic Centre for Family Medicine, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Esther Van Poel
- Equity Research Group, 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
| | - Claire Collins
- Equity Research Group, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Irish College of General Practitioners, Dublin, Ireland
| | - Zalika Klemenc-Ketis
- European Association for Quality and Patient Safety in General Practice/Family Medicine
- Ljubljana Community Health Centre, Ljubljana, Slovenia
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Medical Faculty, University of Maribor, Maribor, Slovenia
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Vandecasteele R, Schelfhout S, D'hondt F, De Maesschalck S, Derous E, Willems S. Intercultural effectiveness in GPs' communication and clinical assessment: An experimental study. Patient Educ Couns 2024; 122:108138. [PMID: 38237531 DOI: 10.1016/j.pec.2024.108138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/27/2023] [Accepted: 01/04/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE This study aimed to investigate potential disparities in general practitioners' overall communication and clinical assessments based on patient ethnicity, while examining the influence of intercultural effectiveness. METHODS Employing a 2 × 2 experimental study design, online video recorded consultations with simulated patients were conducted and analyzed using OSCEs. Each GP (N = 100) completed a consultation with both an ethnic majority and an ethnic minority patient. Additionally, a follow-up survey was administered to gather supplementary data. Paired sample t-tests explored ethnic disparities, correlation and regression analyses determined associations with intercultural attitudes, traits and capabilities. RESULTS No statistically significant differences in GPs' communication or clinical assessment were found based on patients' ethnic background. Positive associations were observed between all aspects of intercultural effectiveness and GPs' consultation behavior. Intercultural traits emerged as a strong and robust predictor of clinical assessment of ethnic minority patients. CONCLUSION Intercultural traits, such as ethnocultural empathy, may play a critical role in GPs' clinical assessment skills during intercultural consultations. PRACTICE IMPLICATIONS Findings provide valuable insights into the determinants of intercultural effectiveness in healthcare, fostering promising targets for interventions and training programs aiming to ensure higher-quality and more equitable care delivery.
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Affiliation(s)
- Robin Vandecasteele
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Stijn Schelfhout
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Work, Organization and Society, Vocational and Personnel Psychology Lab, H. Dunantlaan 2, 9000 Ghent, Belgium; Ghent University, Faculty of Psychology and Educational Sciences, Department of Experimental Psychology, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Fanny D'hondt
- Department of Sociology, Faculty of Political and Social Sciences, Ghent University, Sint-Pietersnieuwstraat 41, 9000 Ghent, Belgium
| | - Stéphanie De Maesschalck
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent University, Centre for the Social Study of Migration and Refugees, H. Dunantlaan 2, 9000 Ghent, Belgium
| | - Eva Derous
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Work, Organization and Society, Vocational and Personnel Psychology Lab, H. Dunantlaan 2, 9000 Ghent, Belgium; Erasmus University Rotterdam, Erasmus School of Social and Behavioural Sciences, Burgemeester Oudlaan 50, 3062 Rotterdam, the Netherlands
| | - Sara Willems
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent University, Centre for the Social Study of Migration and Refugees, H. Dunantlaan 2, 9000 Ghent, Belgium; Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Quality & Safety Ghent, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium
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Cholewa J, Ponsar C, de Rouffignac S, Pétré B, Van Poel E, Willems S, De Jonghe M. General practitioners' well-being in Belgium: results from the cross-sectional PRICOV-19 study. BMC Prim Care 2024; 24:284. [PMID: 38594628 PMCID: PMC11005122 DOI: 10.1186/s12875-024-02341-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The mental health and well-being of GPs is a critical issue as they play a vital role in providing healthcare services to individuals and communities. Research has shown that GPs often face high levels of stress, burnout, and mental health problems due to their demanding work environment. During the COVID-19 pandemic, GPs faced additional challenges which further impacted their mental health and well-being. This study aims to investigate the impact of systemic work-related stressors on the level of well-being of GPs in Belgium during the pandemic, with a particular emphasis on identifying regional variations between Flanders, Wallonia, and Brussels-Capital. METHODS Data were collected with a self-reported online questionnaire from 479 GPs Belgian practices between December 2020 and August 2021 as part of the international PRICOV-19 study that explored the organization of general practices during COVID-19 in 38 countries to guarantee safe, effective, patient-centered, and equitable care. Well-being was evaluated by the Mayo Clinic's expanded 9-item well-being index. RESULTS The findings of this study reveal notable regional discrepancies in the degree of well-being experienced by Belgian GPs, with the Walloon region displaying the lowest level of well-being (37%) in a population highly susceptible to professional distress (57%). Among the key stressors contributing to such distress, financial difficulties among patients (p < 0.011), the fee-for-service payment system (p = 0.013), a lack of work-related purpose (p = 0.047), and inadequate work-life balance (p < 0.001) were identified as significant factors. When examining the influence of regional disparities, it was found that the sole significant interaction between work-related stressors and region regarding the probability of experiencing distress was related to the possibility of workload sharing among practice personnel. CONCLUSION The findings from this study underscore the imperative for more comprehensive research aimed at scrutinizing the differences in well-being across the three regions in Belgium and identifying the systemic factors that influence the practice environment, as opposed to exclusively concentrating on enhancing individual resilience.
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Affiliation(s)
- Joanna Cholewa
- Academic Center of General Medicine, Faculty of Medicine and Dentistry, UCLouvain, Brussels, Belgium
| | - Cecile Ponsar
- Academic Center of General Medicine, Faculty of Medicine and Dentistry, UCLouvain, Brussels, Belgium.
| | - Ségolène de Rouffignac
- Academic Center of General Medicine, Faculty of Medicine and Dentistry, UCLouvain, Brussels, Belgium
| | - Benoit Pétré
- Department of Public Health Sciences, Liège University, Liège, 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
| | - 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
| | - Michel De Jonghe
- Academic Center of General Medicine, Faculty of Medicine and Dentistry, UCLouvain, Brussels, Belgium
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Vanden Bossche D, Van Poel E, Vanden Bussche P, Petré B, Ponsar C, Decat P, Willems S. Outreach work in Belgian primary care practices during COVID-19: results from the cross-sectional PRICOV-19 study. BMC Prim Care 2024; 24:283. [PMID: 38570775 PMCID: PMC10988793 DOI: 10.1186/s12875-024-02323-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/22/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND General practitioners (GPs) have a vital role in reaching out to vulnerable populations during and after the COVID-19 pandemic. Nonetheless, they experience many challenges to fulfill this role. This study aimed to examine associations between practice characteristics, patient population characteristics and the extent of deprivation of practice area on the one hand, and the level of outreach work performed by primary care practices (PCPs) during the COVID-19 pandemic on the other hand. METHODS Belgian data from the international PRICOV-19 study were analyzed. Data were collected between December 2020 and August 2021 using an online survey in PCPs. Practices were recruited through randomized and convenience sampling. Descriptive statistics and ordinal logistic regression analyses were performed. Four survey questions related to outreach work constitute the outcome variable. The adjusted models included four practice characteristics (practice type, being a teaching practice for GP trainees; the presence of a nurse or a nurse assistant and the presence of a social worker or health promotor), two patient population characteristics (social vulnerability and medical complexity) and an area deprivation index. RESULTS Data from 462 respondents were included. First, the factors significantly associated with outreach work in PCPs are the type of PCP (with GPs working in a group performing more outreach work), and the presence of a nurse (assistant), social worker or health promotor. Second, the extent of outreach work done by a PCP is significantly associated with the social vulnerability of the practice's patient population. This social vulnerability factor, affecting outreach work, differed with the level of medical complexity of the practice's patient population and with the level of deprivation of the municipality where the practice is situated. CONCLUSIONS In this study, outreach work in PCPs during the COVID-19 pandemic is facilitated by the group-type cooperation of GPs and by the support of at least one staff member of the disciplines of nursing, social work, or health promotion. These findings suggest that improving the effectiveness of outreach efforts in PCPs requires addressing organizational factors at the practice level. This applies in particular to PCPs having a more socially vulnerable patient population.
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Affiliation(s)
- Dorien Vanden Bossche
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium.
| | - Esther Van Poel
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Pierre Vanden Bussche
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Benoit Petré
- Department of Public Health, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Cécile Ponsar
- Academic Center of Medicine, Institute of Health and Society, UCLouvain, Brussels, Belgium
| | - Peter Decat
- 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
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Van Poel E, Vanden Bussche P, Pétré B, Ponsar C, Collins C, De Jonghe M, Donneau AF, Gillain N, Guillaume M, Willems S. Quality of care in Belgian general practices during the COVID-19 pandemic: results of the cross-sectional PRICOV-19 study. BMC Prim Care 2024; 24:282. [PMID: 38443780 PMCID: PMC10916333 DOI: 10.1186/s12875-024-02305-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/09/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND The COVID-19 pandemic immensely impacted care provision, including quality of care in general practice. This paper aimed: (1) to assess how Belgian general practices acted upon the six dimensions of quality of care during COVID-19; (2) to study differences between the three Belgian regions; and (3) to benchmark the performance of the Belgian practices against the performance in other European countries. METHODS The data collected from 479 Belgian practices during 2020-2021 using an online survey as part of the international cross-sectional PRICOV-19 study were analyzed. Hereby, descriptive statistics, chi-squared tests, and binary logistic regression analyses were performed. Thirty-four survey questions related to the six dimensions of quality of care were selected as outcome variables. The adjusted regression models included four practice characteristics as covariates: practice type, being a teaching practice for GP trainees, multidisciplinarity of the team, and payment system. RESULTS Belgian practices made important organizational changes to deliver high-quality care during COVID-19. Most practices (n = 259; 56.1%) actively reached out to vulnerable patients. Limitations to the practice building or infrastructure threatened high-quality care in 266 practices (55.5%). Infection prevention measures could not always be implemented during COVID-19, such as using a cleaning protocol (n = 265; 57.2%) and providing a separate doctor bag for infection-related home visits (n = 130; 27.9%). Three hundred and sixty practices (82.0%) reported at least one safety incident related to a delayed care process in patients with an urgent condition. The adjusted regression analysis showed limited significant differences between the Belgian regions regarding the quality of care delivered. Belgian practices demonstrated varied performance compared to other European countries. For example, they excelled in always checking the feasibility of isolation at home but reported more patient safety incidents related to timely care than at least three-quarters of the other European countries. CONCLUSIONS Future studies using different design methods are crucial to investigate which country and practice characteristics are associated with delivering high-quality care.
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Affiliation(s)
- 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.
| | - Pierre Vanden Bussche
- 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
| | - Benoît Pétré
- Department of Public Health, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Cécile Ponsar
- Institute of Health and Society, University of Louvain, Louvain, Belgium
| | - Claire Collins
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Research Centre, Irish College of General Practitioners, Dublin, D02 XR68, Ireland
| | - Michel De Jonghe
- Centre Académique de Médecine Générale, Université Catholique de Louvain, Brussels, Belgium
| | | | - Nicolas Gillain
- Department of Public Health, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Michèle Guillaume
- Department of Public Health, Faculty of Medicine, University of Liège, 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
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Springer A, Dreher A, Reimers J, Kaiser L, Bahlmann E, van der Schalk H, Wohlmuth P, Gessler N, Hassan K, Wietz J, Bein B, Spangenberg T, Willems S, Hakmi S, Tigges E. Gender disparities in patients undergoing extracorporeal cardiopulmonary resuscitation. Front Cardiovasc Med 2024; 10:1265978. [PMID: 38292453 PMCID: PMC10824923 DOI: 10.3389/fcvm.2023.1265978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/30/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in extracorporeal cardiopulmonary resuscitation (eCPR) has emerged as a treatment option for selected patients who are experiencing refractory cardiac arrest (CA). In the light of increasing availability, the analyses of outcome-relevant predisposing characteristics are of growing importance. We evaluated the prognostic influence of gender in patients presenting with out-of-hospital cardiac arrest (OHCA) treated with eCPR. Methods We retrospectively analysed the data of 377 consecutive patients treated for OHCA using eCPR in our cardiac arrest centre from January 2016 to December 2022. The primary outcome was defined as the survival of patients until they were discharged from the hospital, with a favourable neurological outcome [cerebral performance category (CPC) score of ≤2]. Statistical analyses were performed using baseline comparison, survival analysis, and multivariable analyses. Results Out of the 377 patients included in the study, 69 (21%) were female. Female patients showed a lower prevalence rate of pre-existing coronary artery disease (48% vs. 75%, p < 0.001) and cardiomyopathy (17% vs. 34%, p = 0.01) compared with the male patients, while the mean age and prevalence rate of other cardiovascular risk factors were balanced. The primary reason for CA differed significantly (female: coronary event 45%, pulmonary embolism 23%, cardiogenic shock 17%; male: coronary event 70%, primary arrhythmia 10%, cardiogenic shock 10%; p = 0.001). The prevalence rate of witnessed collapse (97% vs. 86%; p = 0.016) and performance of bystander CPR (94% vs. 85%; p = 0.065) was higher in female patients. The mean time from collapse to the initiation of eCPR did not differ between the two groups (77 ± 39 min vs. 80 ± 37 min; p = 0.61). Overall, female patients showed a higher percentage of neurologically favourable survival (23% vs. 12%; p = 0.027) despite a higher prevalence of procedure-associated bleeding complications (33% vs. 16%, p = 0.002). The multivariable analysis identified a shorter total CPR duration (p = 0.001) and performance of bystander CPR (p = 0.03) to be associated with superior neurological outcomes. The bivariate analysis showed relevant interactions between gender and body mass index (BMI). Conclusion Our analysis suggests a significant survival benefit for female patients who obtain eCPR, possibly driven by a higher prevalence of witnessed collapse and bystander CPR. Interestingly, the impact of patient age and BMI on neurologically favourable outcome was higher in female patients than in male patients, warranting further investigation.
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Affiliation(s)
- A. Springer
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - A. Dreher
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - J. Reimers
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - L. Kaiser
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - E. Bahlmann
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - H. van der Schalk
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | | | - N. Gessler
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
- Asklepios ProResearch, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - K. Hassan
- Department of Cardiac Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
| | - J. Wietz
- Department of Emergency Medicine, Asklepios Clinic St. Georg, Hamburg, Germany
| | - B. Bein
- Department of Anaesthesiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - T. Spangenberg
- Department of Cardiology and Critical Care, Asklepios Clinic Altona, Hamburg, Germany
| | - S. Willems
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Semmelweis-University, Budapest, Hungary
| | - S. Hakmi
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Department of Cardiac Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
| | - E. Tigges
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
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Springer A, Dreher A, Reimers J, Kaiser L, Bahlmann E, van der Schalk H, Wohlmuth P, Gessler N, Hassan K, Wietz J, Bein B, Spangenberg T, Willems S, Hakmi S, Tigges E. Prognostic influence of mechanical cardiopulmonary resuscitation on survival in patients with out-of-hospital cardiac arrest undergoing ECPR on VA-ECMO. Front Cardiovasc Med 2024; 10:1266189. [PMID: 38274309 PMCID: PMC10808304 DOI: 10.3389/fcvm.2023.1266189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in extracorporeal cardiopulmonary resuscitation (ECPR) in selected patients after out-of-hospital cardiac arrest (OHCA) is an established method if return of spontaneous circulation cannot be achieved. Automated chest compression devices (ACCD) facilitate transportation of patients under ongoing CPR and might improve outcome. We thus sought to evaluate prognostic influence of mechanical CPR using ACCD in patients presenting with OHCA treated with ECPR including VA-ECMO. Methods We retrospectively analyzed data of 171 consecutive patients treated for OHCA using ECPR in our cardiac arrest center from the years 2016 to 2022. A Cox proportional hazards model was used to identify characteristics related with survival. Results Of the 171 analyzed patients (84% male, mean age 56 years), 12% survived the initial hospitalization with favorable neurological outcome. The primary reason for OHCA was an acute coronary event (72%) followed by primary arrhythmia (9%) and non-ischemic cardiogenic shock (6.7%). In most cases, the collapse was witnessed (83%) and bystander CPR was performed (83%). The median time from collapse to VA-ECMO was 81 min (Q1: 69 min, Q3: 98 min). No survival benefit was seen for patients resuscitated using ACCD. Patients in whom an ACCD was used presented with overall longer times from collapse to ECMO than those who were resuscitated manually [83 min (Q1: 70 min, Q3: 98 min) vs. 69 min (Q1: 57 min, Q3: 84 min), p = 0.004]. Conclusion No overall survival benefit of the use of ACCD before ECPR is established was found, possibly due to longer overall CPR duration. This may arguably be because of the limited availability of ACCD in pre-clinical paramedic service at the time of observation. Increasing the availability of these devices might thus improve treatment of OHCA, presumably by providing efficient CPR during transportation and transfer.
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Affiliation(s)
- A. Springer
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - A. Dreher
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - J. Reimers
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - L. Kaiser
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - E. Bahlmann
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - H. van der Schalk
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | | | - N. Gessler
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
- Asklepios ProResearch, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - K. Hassan
- Department of Cardiac Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
| | - J. Wietz
- Department of Emergency Medicine, Asklepios Clinic St. Georg, Hamburg, Germany
| | - B. Bein
- Department of Anaesthesiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - T. Spangenberg
- Department of Cardiology and Critical Care, Asklepios Clinic Altona, Hamburg, Germany
| | - S. Willems
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Semmelweis-University, Budapest, Hungary
| | - S. Hakmi
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Department of Cardiac Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
| | - E. Tigges
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
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Viegas L, Dupie I, Rigal L, Van Poel E, Willems S, Beaupin A, Falcoff H. Triage of patients and remote consultations in primary care facilities during the COVID-19 pandemic in France (PRICOV-19 study). Sante Publique 2023; 35:393-403. [PMID: 38078634 DOI: 10.3917/spub.234.0393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Introduction PRICOV-19 is a European cross-sectional study based on an online questionnaire, describing the impact of the pandemic on primary care structures (PCS). In France, PCS are solo practices (SP), single or multi-professional group practices (GP), coordinated practice structures (CPS): health houses and health centers. Triage, whether it is digital (TD), by telephone (TT) or at the reception (TR), is essential to reduce the risk of infection, and is part of recommended organizational practices. Purpose of research Based on French data from the PRICOV-19 study, the objective is to describe the frequency and factors associated with triage in PCSs during the COVID 19 pandemic. Results 1100 structures responded to the survey. The TD was implemented in 64% of PCSs (53.3% of SPs, 64.9% of GPs, 73.2% of CPSs). The TT was implemented in 76% of structures (72.7% of SPs, 75.4% of GPs and 81% of CPSs). Finally, TR was implemented in 52% of structures (37.7% of SPs, 52% of GPs and 67% of CPSs). The other positively associated factors are the urban territory and the lower workload for the TD, and the presence of a receptionist for the TR. Conclusions Triage practices seem to be clearly associated with the organization and working conditions in the PCSs, and first and foremost with the type of structure.
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Affiliation(s)
- Laura Viegas
- Dep. Médecine Générale, Sorbonne Université Paris – Paris – France
| | | | - Laurent Rigal
- Département de Médecine générale, Université Paris-Saclay – France
- Département de Médecine générale, Le Kremlin-Bicêtre – France
| | - Esther Van Poel
- Département de Santé Publique et Soins Primaires – 9000 Gand – Belgique
| | - Sara Willems
- Département de Santé Publique et Soins Primaires – 9000 Gand – Belgique
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Gomezelj MC, Miroševič Š, Tajki AV, Bunc KT, Van Poel E, Willems S, Klemenc-Ketiš Z. The safety of patient management in family medicine in Slovenia during Covid-19: a cross-sectional study. BMC Prim Care 2023; 24:255. [PMID: 38031008 PMCID: PMC10687777 DOI: 10.1186/s12875-023-02209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND During the Covid-19 pandemic, family medicine practices (FMPs) changed to improve safety against new coronavirus infections for both patients and employees. Protocols for treating patients with suspected Sars-Cov-2 infections were established to protect medical staff and other patients from being infected. However, these protocols also led to increased safety risks, such as delays in treating patients with other medical conditions. This exploratory study aimed to investigate safety risks in treating patients in FMPs during the Covid-19 pandemic and to suggest improvements to prevent Covid-19 in FMPs in Slovenia. METHODS A cross-sectional study was rolled out in FMPs in Slovenia as part of the international Pricov-19 study. Data collection on safety management during the Covid-19 pandemic in FMPs in Slovenia took place from November 2020 until January 2021 using a self-administered online survey for FP working in Slovenia. A chi-square test, ANOVA, independent samples t-test or bivariate correlation test was performed to explore associations regarding the safety of patients' management variables. RESULTS From the 191 participating family physicians (FPs) (15.2% response rate), 54.8% reported having treated patients with fever (not Covid-19) late due to the new protocols at least once, and 54.8% reported patients with urgent conditions having been seen late at least once due to not coming. In the suburbs and rural environments FPs more often reported that at least once patient with a fever (not Covid-19) was seen late due to the protocol (p = 0.017) and more often reported that at least once patient with an urgent condition was seen late due to not coming to their FP (p = 0.017). The larger the practice, the more they reported that at least once a patient with fever (not Covid-19) was seen late due to the protocol (p = 0.012) and the more they reported at least once a patient with an urgent condition was seen late due to not coming to their FP (p = 0.012). CONCLUSION Covid-19 affected the safety of patient management in FMP in Slovenia. The most common problem was foregone care. Therefor, protocols for chronic patient management in the event of epidemics need to be established.
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Affiliation(s)
- Maja Cvetko Gomezelj
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
| | - Špela Miroševič
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Alina Verdnik Tajki
- Department of Family Medicine, Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Ksenija Tušek Bunc
- Department of Family Medicine, Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Zalika Klemenc-Ketiš
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Medical Faculty, University of Maribor, Maribor, Slovenia
- Ljubljana Community Health Centre, Ljubljana, Slovenia
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Rongen APM, Willems S, Bruhn J, Rex S, Devroe S, Özkan S, van de Velde M. Unwarranted association between epidural analgesia and emergency delivery: critical review of methodological shortcomings. Ultrasound Obstet Gynecol 2023; 62:754-755. [PMID: 37910796 DOI: 10.1002/uog.27487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/13/2023] [Indexed: 11/03/2023]
Abstract
Linked articles: This Correspondence comments on Damhuis et al. and Tabernée Heijtmeijer et al.
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Affiliation(s)
- A P M Rongen
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - S Willems
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Bruhn
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Rex
- Department of Anesthesiology, KU Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - S Devroe
- Department of Anesthesiology, KU Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - S Özkan
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M van de Velde
- Department of Anesthesiology, KU Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Eide TB, van Poel E, Willems S, Jacobsen FF. Changes in work tasks and organization of general practice in Norway during the COVID-19 pandemic: results from a comparative international study. BMC Prim Care 2023; 24:227. [PMID: 37898780 PMCID: PMC10613352 DOI: 10.1186/s12875-023-02146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 08/30/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND The COVID-19 pandemic led to huge and rapid changes in general practice in Norway as in the rest of Europe. This paper aims to explore to what extent the COVID-19 pandemic changed the work tasks and organization of Norwegian general practice. MATERIAL AND METHOD We analysed data from the Norwegian part of the international, cross-sectional PRICOV-19 study, collecting data from general practice via an online self-reported questionnaire. We included 130 Norwegian general practices, representing an estimated 520 Norwegian general practitioners (GPs). All Norwegian GPs were invited to participate. In the analyses, we focused on items related to the use of alternatives to face-to-face consultations, changes in the workload, tasks and delegated responsibilities of both the GPs and other personnel in the GP offices, adaptations in routines related to hygiene measures, triage of patients, and how the official rules and recommendations affected the practices. RESULTS There was a large and significant increase in the use of all forms of alternative consultation forms (digital text-based, video- and telephone consultations). The use of several different infection prevention measures were significantly increased, and the provision of hand sanitizer to patients increased from 29.6% pre-pandemic to 95.1% since the pandemic. More than half of the GPs (59.5%) reported that their responsibilities in the practice had increased, and 41% were happy with the task shift. 27% felt that they received adequate support from the government; however, 20% reported that guidelines from the government posed a threat to the well-being of the practice staff. We found no associations with the rurality of the practice location or size of the municipalities. CONCLUSION Norwegian GPs adapted well to the need for increased use of alternatives to face-to-face consultations, and reported a high acceptance of their increased responsibilities. However, only one in four received adequate support from the government, which is an important learning point for similar situations in the future.
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Affiliation(s)
- Torunn Bjerve Eide
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - 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
| | - 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
| | - Frode F Jacobsen
- Centre for Care Research West, Western Norway University of Applied Sciences, Bergen, Norway.
- VID Specialized University, Bergen, Norway.
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Delvento G, Curteanu A, Rotaru C, Van Poel E, Willems S, Prytherch H, Curocichin G. The impact of the COVID-19 pandemic on primary health care practices and patient management in the Republic of Moldova - results from the PRICOV-19 survey. BMC Prim Care 2023; 24:221. [PMID: 37880576 PMCID: PMC10598887 DOI: 10.1186/s12875-023-02116-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 07/20/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND The COVID-19 pandemic has had an enormous impact on health systems in Europe and has generated unprecedented challenges for tertiary care. Less is known about the effects on the activities of local family doctors (FDs), who have shifted tasks and adapted their practice to accommodate the new services brought by the pandemic. The PRICOV-19 study was a multi-country survey aiming to understand the challenges posed by the pandemic in primary health care (PHC) practices around Europe. Within the framework of this study, we assessed the impact of the pandemic on PHC facilities in urban, rural, and mixed urban/rural areas in the Republic of Moldova. METHODS We present the results from the PRICOV-19 questionnaire designed at Ghent University (Belgium) and distributed between January and March 2021 to PHC facilities from the 35 districts of the Republic of Moldova. This analysis presents descriptive data on limitations to service delivery, staff role changes, implementation and acceptance of COVID-19 guidelines, and incidents reported on staff and patient safety during the pandemic. RESULTS Results highlighted the differences between facilities located in urban, rural, and mixed areas in several dimensions of PHC. Nearly half of the surveyed facilities experienced limitations in the building or infrastructure when delivering services during the pandemic. 95% of respondents reported an increase in time spent giving information to patients by phone, and 88% reported an increase in responsibilities. Few practices reported errors in clinical assessments, though a slightly higher number of incidents were reported in urban areas. Half of the respondents reported difficulties delivering routine care to patients with chronic conditions and a delay in treatment-seeking. CONCLUSIONS During the pandemic, the workload of PHC staff saw a significant increase, and practices met important structural and organizational limitations. Consequently, these limitations may have also affected care delivery for vulnerable patients with chronic conditions. Adjustments and bottlenecks need to be addressed, considering the different needs of PHC facilities in urban, rural, and mixed areas.
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Affiliation(s)
- Giulia Delvento
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.
- University of Basel, P.O. Box, CH-4003, Basel, Switzerland.
| | - Ala Curteanu
- Healthy Life project: Reducing the Burden of Non-Communicable Diseases in Moldova, Chișinău, Moldova
- Swiss Agency for Development and Cooperation (SDC), Chișinău, Moldova
- Mother and Child Institute, Chișinău, Republic of Moldova
| | - Cristina Rotaru
- Healthy Life project: Reducing the Burden of Non-Communicable Diseases in Moldova, Chișinău, Moldova
- Swiss Agency for Development and Cooperation (SDC), Chișinău, Moldova
- Nicolae Testemitanu Medical University, Chișinău, Republic of Moldova
| | - 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
| | - 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
| | - Helen Prytherch
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland
- University of Basel, P.O. Box, CH-4003, Basel, Switzerland
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Stummer FO, Voggenberger L, Gomez Pellin MDLC, van Poel E, Willems S, Hoffmann K. Insights into the use of telemedicine in primary care in times of the SARS-CoV-2 pandemic - a cross-sectional analysis based on the international PRICOV-19 study in Austria. BMC Prim Care 2023; 24:218. [PMID: 37875808 PMCID: PMC10598885 DOI: 10.1186/s12875-023-02113-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/18/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND The SARS-CoV2 pandemic as well as the implementation of public health measures to decrease the spread of the virus re-sparked the call for "virtual" health or "distance" treatments. This paper aimed to assess the use of video consultations, the up-to-dateness of practice websites, and the views of GPs on whether eHealth is a positive aspect for the future of their practices in publicly -funded primary healthcare facilities in Austria. METHODS The cross-sectional online questionnaire, part of the PRICOV-19 study, was conducted from December 2020 until July 2021. We randomly recruited 176 GP practices across Austria. Descriptive statistics as well as binary logistic regression models were applied to examine the associations between telemedicine use and practice factors. RESULTS Compared with before the pandemic (3.8%), 7.6% of publicly funded GP practices have been using video consultations since the pandemic. In line with this, 93.9% of the practices had no increase in video consultation use. Fewer than half (44.3%) had an up-to-date webpage, and 27.8% assumed that the pandemic might have been a positive driver for eHealth in their practices. Positive associations with video consultation use could be found in practices with fewer patients aged 70 years and over than the average and more patients with chronic diseases than the average. CONCLUSION The use of video consultations in general practice and the readiness for other telemedicine approaches are both very low in Austria. Austria has to urgently follow the example of countries with a transparent and comprehensive national digital health strategy that includes video consultation. Without a proper payment system, patient inclusion, and support with regard to administrative and organizational aspects, no substantial change will occur in spite of an increase in need due to the pandemic and changes in the patient population.
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Affiliation(s)
- Florian Odilo Stummer
- Department of Primary Care Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Lisa Voggenberger
- Institute for General Medicine, Johannes-Kepler-University, Linz, Austria
| | | | - Esther van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kathryn Hoffmann
- Department of Primary Care Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.
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Leyns C, Willems S, Powell RA, Camacho V, Fabrega R, De Maeseneer J, Rawaf S, Mangtani P, El-Osta A. From disease- to people-centred pandemic management: organized communities, community-oriented primary care and health information systems. Int J Equity Health 2023; 22:225. [PMID: 37872591 PMCID: PMC10591360 DOI: 10.1186/s12939-023-02032-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/05/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic exposed the health equity gap between and within countries. Western countries were the first to receive vaccines and mortality was higher among socially deprived, minority and indigenous populations. Surprisingly, many sub-Saharan countries reported low excess mortalities. These countries share experiences with community organization and participation in health. The aim of this article was to analyse if and how this central role of people can promote a successful pandemic response. METHODS This analysis was partly based on local and national experiences shared during an international and Latin American conference on person-and people-centred care in 2021. Additionally, excess mortality data and pandemic control-relevant data, as well as literature on the pandemic response of countries with an unexpected low excess mortality were consulted. RESULTS Togo, Mongolia, Thailand and Kenya had a seven times lower mean excess mortality for 2020 and 2021 than the United States of America. More successful pandemic responses were observed in settings with experience in managing epidemics like Ebola and HIV, well-established community networks, a national philosophy of mutual aid, financial government assistance, more human resources for primary care and paid community health workers. DISCUSSION Since trust in authorities and health needs vary greatly, local strategies are needed to complement national and international pandemic responses. Three key levers were identified to promote locally-tailored pandemic management: well-organized communities, community-oriented primary care, and health information systems. An organized community structure stems from a shared ethical understanding of humanity as being interconnected with each other and the environment. This structure facilitates mutual aid and participation in decision making. Community-oriented primary care includes attention for collective community health and ways to improve health from its roots. A health information system supports collective health and health equity analysis by presenting health needs stratified for social deprivation, ethnicity, and community circumstances. CONCLUSIONS The difference in excess mortality between countries during the COVID-19 pandemic and various country experiences demonstrate the potential of the levers in promoting a more just and effective health emergency response. These same levers and strategies can promote more inclusive and socially just health systems.
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Affiliation(s)
- Christine Leyns
- Research Institute of Social Sciences (INCISO), Faculty of Social Sciences, Universidad Mayor de San Simon, Cochabamba, Bolivia.
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Sara Willems
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Richard A Powell
- Department of Primary Care and Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Vivian Camacho
- High Level Commissioner at "Alma Ata 40 years High Level Commission for PAHO", National Director inside Health Ministry in Bolivia, La Paz, Bolivia
| | - Ricardo Fabrega
- Dean, Faculty of Health Sciences, Universidad Santo Tomás de Chile, Santiago, Chile
| | - Jan De Maeseneer
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Salman Rawaf
- Department of Primary Care and Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Punam Mangtani
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Austen El-Osta
- Department of Primary Care and Public Health, Faculty of Medicine, Imperial College London, London, UK
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Stark S, Schaubroeck E, Kluge M, Burggraf L, Roos M, Borowski E, Van Poel E, Willems S, Kühlein T, Hueber S, Werner F. "The measures taken by the government overburdened the daily practice" - insights of the PRICOV-19 study on German general practitioners in times of COVID-19. BMC Prim Care 2023; 24:207. [PMID: 37821802 PMCID: PMC10568746 DOI: 10.1186/s12875-023-02115-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/18/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The international study PRICOV-19 aims to assess the impact of the COVID-19 pandemic on the organisation of primary health care. The German part focuses on German general practitioners during the second wave of the COVID-19 pandemic. This paper addresses the following research questions: (1) How were changes in tasks on primary care and patient treatment perceived by GPs?, (2) What was the role of GPs during the pandemic, and how was their wellbeing?, (3) How did GPs perceive health policy measures?, and, (4) What influenced the attitudes of GPs on health policy measures? METHODS This study pursues a multi-country cross-sectional design. Data collection took place throughout Germany from 01.02. to 28.02.2021 with a quantitative online questionnaire consisting of 53 items. The questionnaire was analysed through descriptive and inferential analyses using correlation and multiple regression models. RESULTS The response rate was 20.4% (n = 349). The respondents were mainly GPs (59.6%) in single practices (62.5%) with a mean work experience of 15 to 20 years. GPs experienced a change in their work and practice organisation (80.3%). They felt a high responsibility (70.6%) and found their work has become more meaningful to them (76%). They also saw a lack of political support (75.2%) and that the measures taken by the government overburdened the daily practice (66.4%). Not many GPs were at risk of being distressed (53.4%) but rated the health policies rather negatively (60%). The multiple regression showed, the more GPs were exposed to risk of distress, the worse they assessed the government's measures. CONCLUSION GPs perceived their work as relevant and felt confident they could fulfil their tasks, but noticed that health policy initially hardly supported the outpatient sector. Health policies should increase their competence in relation to primary care, ensure its needs and consider an active inclusion of GPs in preparedness plans.
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Affiliation(s)
- Stefanie Stark
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Emmily Schaubroeck
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Marie Kluge
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Larissa Burggraf
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department for Sociology, University of Education, Schwäbisch Gmünd, Germany
| | - Marco Roos
- General Practice, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Eve Borowski
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Thomas Kühlein
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Susann Hueber
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Felix Werner
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Leyns CC, Stilma Memelink D, Bullinga L, De Maeseneer J, Willems S, Campman Melssen C. Integrated person- and people-centred primary care for diabetes in low- and middle-income countries: The nurses' perspective on patient needs. J Adv Nurs 2023; 79:4044-4057. [PMID: 37427833 DOI: 10.1111/jan.15760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 05/03/2023] [Accepted: 06/16/2023] [Indexed: 07/11/2023]
Abstract
AIMS The aim of this study was to identify what nurses working in primary care settings perceive as necessary to support the life needs of people with type 2 diabetes. Articulate these needs with the needs expressed by people with diabetes in a previous study. Finally, illustrate the potential of the used method. DESIGN A highly structured qualitative group method for brainstorming and idea sharing was used to generate a participant-owned concept map that can support and evaluate practice change. METHODS Data were collected between April and May 2022 in two public primary healthcare centres in Sacaba, Bolivia, with 33 professional nurses, technical nurses, nurse trainees and one physician. The concept mapping process by Trochim was used to generate, share and structure ideas, maximizing equality of input. RESULTS The nurses identified 73 unique needs that were structured in 11 conceptual clusters related to four different stakeholders or domains: organization of care and health policy, strengthening knowledge, skills and attitudes of healthcare providers, empower people living with diabetes and their family, and community-level health promotion and diabetes education. CONCLUSION The needs and domains identified by nurses and people with type 2 diabetes are very similar and inform a multisectoral and transdisciplinary action plan to jointly monitor and evaluate progress towards people-centred care for people with diabetes. IMPACT This study demonstrates nurses' important contribution to analysing and designing people-centred care in their community. They identify and act upon social determinants of health related to schools, safety and legislation. Besides global relevance, results inform the municipal health plan and an ongoing research project on cardiometabolic health. PATIENT OR PUBLIC CONTRIBUTION Data from prior patient consultations were included in the study design, and study results inform the municipal health plan.
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Affiliation(s)
- Christine Cecile Leyns
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Research Institute of Social Sciences, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | | | | | - Jan De Maeseneer
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Groenewegen PP, van den Muijsenbergh M, Batenburg R, Van Poel E, van den Broek S, Bussche PV, Willems S. Quick adaptation of the organisation of general practices during the COVID-19 pandemic in the Netherlands. BMC Prim Care 2023; 24:170. [PMID: 37653405 PMCID: PMC10472546 DOI: 10.1186/s12875-023-02114-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 07/18/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND General practices have adapted the practice organisation to the circumstances of the COVID-19 pandemic. In this article we describe several adjustments in general practices in the field of patient flow management, appointments, triage, referral and infection prevention. We also examined how practices relate to the policy of the government and of the professional organisations during the pandemic. METHODS A cross-sectional online survey was conducted among a sample of 893 general practitioners (GPs) during February and March 2021. The response rate was 17%. Because the questionnaire concerns practices and not individual GPs, one practice owner per practice received an invitation with a link to the online questionnaire. One reminder has been sent. RESULTS General practices adapted their organisation during the corona pandemic, partly based on information and advice from their professional organisations. The adjustments were necessary to ensure that patient care continued as much and as safely as possible, often remotely. The use of video consultations quickly increased from 6% to 65% of the practices. The cooperation with neighbouring practices improved and practices felt supported by the professional organisations. CONCLUSIONS The pandemic itself, remote care and stricter patient flow management have put pressure on the quality of care and patient safety. The accessibility of the practices was sometimes limited. In the perception of patients, this was stronger than in reality.
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Affiliation(s)
- Peter P Groenewegen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands.
| | | | - Ronald Batenburg
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Esther Van Poel
- Department of Public Health and Primary Care, Quality and Safety, Ghent, Belgium
| | | | | | - Sara Willems
- Department of Public Health and Primary Care, Quality and Safety, Ghent, Belgium
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18
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Vanden Bossche D, Zhao QJ, Ares-Blanco S, Peña MPA, Decat P, Kondo N, Kroneman M, Nishioka D, Petrazzuoli F, Rortveit G, Schaubroeck E, Stark S, Pinto AD, Willems S. Addressing health inequity during the COVID-19 pandemic through primary health care and public health collaboration: a multiple case study analysis in eight high-income countries. Int J Equity Health 2023; 22:171. [PMID: 37653472 PMCID: PMC10472729 DOI: 10.1186/s12939-023-01968-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic substantially magnified the inequity gaps among vulnerable populations. Both public health (PH) and primary health care (PHC) have been crucial in addressing the challenges posed by the pandemic, especially in the area of vulnerable populations. However, little is known about the intersection between PH and PHC as a strategy to mitigate the inequity gap. This study aims to assess the collaboration between PHC and PH with a focus on addressing the health needs of vulnerable populations during the COVID-19 pandemic across jurisdictions. METHODS We analyzed and compared data from jurisdictional reports of COVID-19 pandemic responses in PHC and PH in Belgium, Canada (Ontario), Germany, Italy, Japan, the Netherlands, Norway, and Spain from 2020 to 2021. RESULTS Four themes emerge from the analysis: (1) the majority of the countries implemented outreach strategies targeting vulnerable groups as a means to ensure continued access to PHC; (2) digital assessment in PHC was found to be present across all the countries; (3) PHC was insufficiently represented at the decision-making level; (4) there is a lack of clear communication channels between PH and PHC in all the countries. CONCLUSIONS This study identified opportunities for collaboration between PHC and PH to reduce inequity gaps and to improve population health, focusing on vulnerable populations. The COVID-19 response in these eight countries has demonstrated the importance of an integrated PHC system. Consequently, the development of effective strategies for responding to and planning for pandemics should take into account the social determinants of health in order to mitigate the unequal impact of COVID-19. Careful, intentional coordination between PH and PHC should be established in normal times as a basis for effective response during future public health emergencies. The pandemic has provided significant insights on how to strengthen health systems and provide universal access to healthcare by fostering stronger connections between PH and PHC.
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Affiliation(s)
- Dorien Vanden Bossche
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Q Jane Zhao
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
| | - Sara Ares-Blanco
- Federica Montseny Primary Care Centre, Madrid, Spain
- Patient Safety Working Party of semFYC (Spanish Society for Family and Community Medicine), Madrid, Spain
| | - Maria Pilar Astier Peña
- Patient Safety Working Party of semFYC (Spanish Society for Family and Community Medicine), Madrid, Spain
- Territorial Healthcare Quality Unit, Camp de Tarragona, Health Department Generalitat de Catalunya, Healthcare Institute of Catalonia, Tarragona, Spain
| | - Peter Decat
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Naoki Kondo
- Department of Social Epidemiology, University of Kyoto, Kyoto, Japan
| | - Madelon Kroneman
- Nivel (Netherlands Institute of Health Services Research), Utrecht, the Netherlands
| | - Daisuke Nishioka
- Department of Medical Statistics, Research & Development Center, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Guri Rortveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Emmily Schaubroeck
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stefanie Stark
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Andrew D Pinto
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- St Michael's Hospital, Toronto, ON, Canada
| | - Sara Willems
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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19
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Van Iseghem T, Jacobs I, Vanden Bossche D, Delobelle P, Willems S, Masquillier C, Decat P. The role of community health workers in primary healthcare in the WHO-EU region: a scoping review. Int J Equity Health 2023; 22:134. [PMID: 37474937 PMCID: PMC10357780 DOI: 10.1186/s12939-023-01944-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/26/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Existing evidence on the role of community health workers (CHWs) in primary healthcare originates primarily from the United States, Canada and Australia, and from low- and middle-income countries. Little is known about the role of CHWs in primary healthcare in European countries. This scoping review aimed to contribute to filling this gap by providing an overview of literature reporting on the involvement of CHWs in primary healthcare in WHO-EU countries since 2001 with a focus on the role, training, recruitment and remuneration. METHODS This systematic scoping review followed the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses, extension for Scoping Reviews. All published peer-reviewed literature indexed in PubMed, Web of Science, and Embase databases from Jan 2001 to Feb 2023 were reviewed for inclusion. Included studies were screened on title, abstract and full text according to predetermined eligibility criteria. Studies were included if they were conducted in the WHO-EU region and provided information regarding the role, training, recruitment or remuneration of CHWs. RESULTS Forty studies were included in this review, originating from eight countries. The involvement of CHWs in the WHO-EU regions was usually project-based, except in the United Kingdom. A substantial amount of literature with variability in the terminology used to describe CHWs, the areas of involvement, recruitment, training, and remuneration strategies was found. The included studies reported a trend towards recruitment from within the communities with some form of training and payment of CHWs. A salient finding was the social embeddedness of CHWs in the communities they served. Their roles can be classified into one or a combination of the following: educational; navigational and supportive. CONCLUSION Future research projects involving CHWs should detail their involvement and elaborate on CHWs' role, training and recruitment procedures. In addition, further research on CHW programmes in the WHO-EU region is necessary to prepare for their integration into the broader national health systems.
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Affiliation(s)
- Tijs Van Iseghem
- Interuniversity Centre for Health Economics Research (ICHER), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Ilka Jacobs
- Equity Research Group, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Dorien Vanden Bossche
- Unit Family Medicine, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Peter Delobelle
- Chronic Diseases Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
- MENT Research Group, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sara Willems
- Equity Research Group, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Caroline Masquillier
- 'Family Medicine and Population Health' - FAMPOP, Faculty of Medical Sciences & 'Centre for Family, Population and Health', Faculty of Social sciences, University of Antwerp, Antwerp, Belgium
| | - Peter Decat
- Unit Family Medicine, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Leta K, Lauwerier E, Willems S, Vermeersch S, Demeester B, Verloigne M. Smoking prevention within social work organizations: a qualitative study about youngsters' and youth workers' perceptions. Health Promot Int 2023; 38:7171694. [PMID: 37202340 DOI: 10.1093/heapro/daad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Tobacco smoking uptake is still a major public health concern, especially among youngsters living in vulnerable situations. Finding optimal ways to engage youngsters in smoking prevention is important. Compared to traditional settings such as schools, social work settings providing sports-based and recreational activities (SR-settings) tend to reach and engage youngsters more. This study aimed to gain insight into the reasons for smoking uptake among youngsters living in vulnerable situations and the conditions through which SR-settings are potentially beneficial for smoking prevention initiatives. Data were collected in two SR-settings in Flanders, Belgium, by means of five focus group discussions and six individual interviews with youngsters (n = 38, mean age = 12.9 ± 2.61 years, 69.7% boys) and eight individual interviews with youth workers (n = 8, mean age = 27.5 ± 7.95 years, 87.5% men). A thematic analysis (TA) approach was applied to analyse the data. Besides individual factors, such as attitudes towards smoking, the desire to be part of a group and conformity to group norms seem to be important drivers of smoking uptake among youngsters in vulnerable situations. The presence of powerful role models in SR-settings with whom youngsters identify may counteract group norms by encouraging healthy behaviour. SR-settings seem suitable for questioning perceptions of vulnerable youngsters, unlike other settings where they may struggle to be heard. The conditional characteristics of SR-settings, such as authentic group processes, having meaningful roles, and being heard, make these contexts promising venues for smoking prevention efforts among vulnerable youngsters. Youth workers who have established trusting relationships with youngsters seem well-suited to communicate smoking prevention messages. A participatory approach, in which youngsters are involved in developing smoking prevention programs, is desirable.
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Affiliation(s)
- Kenji Leta
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Emelien Lauwerier
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Sarah Vermeersch
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Babette Demeester
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Maïté Verloigne
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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21
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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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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22
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Petrazzuoli F, Collins C, Van Poel E, Tatsioni A, Streit S, Bojaj G, Asenova R, Hoffmann K, Gabrani J, Klemenc-Ketis Z, Rochfort A, Adler L, Windak A, Nessler K, Willems S. Differences between Rural and Urban Practices in the Response to the COVID-19 Pandemic: Outcomes from the PRICOV-19 Study in 38 Countries. Int J Environ Res Public Health 2023; 20:3674. [PMID: 36834369 PMCID: PMC9958860 DOI: 10.3390/ijerph20043674] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
This paper explores the differences between rural and urban practices in the response to the COVID-19 pandemic, emphasizing aspects such as management of patient flow, infection prevention and control, information processing, communication and collaboration. Using a cross-sectional design, data were collected through the online PRICOV-19 questionnaire sent to general practices in 38 countries. Rural practices in our sample were smaller than urban-based practices. They reported an above-average number of old and multimorbid patients and a below-average number of patients with a migrant background or financial problems. Rural practices were less likely to provide leaflets and information, but were more likely to have ceased using the waiting room or to have made structural changes to their waiting room and to have changed their prescribing practices in terms of patients attending the practices. They were less likely to perform video consultations or use electronic prescription methods. Our findings show the existence of certain issues that could impact patient safety in rural areas more than in urban areas due to the underlying differences in population profile and supports. These could be used to plan the organization of care for similar future pandemic situations.
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Affiliation(s)
- Ferdinando Petrazzuoli
- Department of Clinical Sciences, Centre for Primary Health Care Research, Lund University, 21428 Malmö, Sweden
| | - Claire Collins
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Gazmend Bojaj
- Department of Management of Health Services and Institution, Heimerer College, 1000 Pristina, Kosovo
| | - Radost Asenova
- Department of Urology and General Practice, Faculty of Medicine, Medical University Plovdiv, 4003 Plovdiv, Bulgaria
| | - Kathryn Hoffmann
- Department of Social- and Preventive Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Jonila Gabrani
- Faculty of Medicine, University of Basel, 4001 Basel, Switzerland
| | - Zalika Klemenc-Ketis
- Department of Family Medicine, Medical Faculty, University of Maribor, Tabroska 8, 2000 Maribor, Slovenia
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Poljanski Nasip 58, 1000 Ljubljana, Slovenia
- Ljubljana Community Health Centre, Metelkova 9, 1000 Ljubljana, Slovenia
| | - Andrée Rochfort
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
| | - Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6195001, Israel
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, 31-061 Krakow, Poland
| | - Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, 31-061 Krakow, Poland
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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23
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Fomenko E, Keygnaert I, Van Poel E, Collins C, Gómez Bravo R, Korhonen P, Laine MK, Murauskiene L, Tatsioni A, Willems S. Screening for and Disclosure of Domestic Violence during the COVID-19 Pandemic: Results of the PRICOV-19 Cross-Sectional Study in 33 Countries. Int J Environ Res Public Health 2023; 20:3519. [PMID: 36834213 PMCID: PMC9964689 DOI: 10.3390/ijerph20043519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic left no one untouched, and reports of domestic violence (DV) increased during the crisis. DV victims rarely seek professional help, yet when they do so, they often disclose it to their general practitioner (GP), with whom they have a trusting relationship. GPs rarely screen and hence rarely take the initiative to discuss DV with patients, although victims indicate that offering this opportunity would facilitate their disclosure. This paper aims to describe the frequency of screening for DV by GPs and disclosure of DV by patients to the GP during the COVID-19 pandemic, and to identify key elements that could potentially explain differences in screening for and disclosure of DV. The PRICOV-19 data of 4295 GP practices from 33 countries were included in the analyses, with practices nested in countries. Two stepwise forward clustered ordinal logistic regressions were performed. Only 11% of the GPs reported (much) more disclosure of DV by patients during COVID-19, and 12% reported having screened for DV (much). Most significant associations with screening for and disclosure of DV concerned general (pro)active communication. However, (pro)active communication was performed less frequently for DV than for health conditions, which might indicate that GPs are insufficiently aware of the general magnitude of DV and its impact on patients and society, and its approach/management. Thus, professional education and training for GPs about DV seems highly and urgently needed.
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Affiliation(s)
- Elizaveta Fomenko
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Ines Keygnaert
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Claire Collins
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
| | - Raquel Gómez Bravo
- Centre Hospitalier Neuropsychiatrique, 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
| | - Päivi Korhonen
- Department of General Practice, University of Turku and Turku University Hospital, 20521 Turku, Finland
| | - Merja K. Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland
- Folkhälsan Research Center, 00280 Helsinki, Finland
| | - Liubove Murauskiene
- Public Health Department, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania
| | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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24
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Van Poel E, Collins C, Groenewegen P, Spreeuwenberg P, Bojaj G, Gabrani J, Mallen C, Murauskiene L, Šantrić Milićević M, Schaubroeck E, Stark S, Willems S. The Organization of Outreach Work for Vulnerable Patients in General Practice during COVID-19: Results from the Cross-Sectional PRICOV-19 Study in 38 Countries. Int J Environ Res Public Health 2023; 20:3165. [PMID: 36833862 PMCID: PMC9960761 DOI: 10.3390/ijerph20043165] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic disproportionately affected vulnerable populations' access to health care. By proactively reaching out to them, general practices attempted to prevent the underutilization of their services. This paper examined the association between practice and country characteristics and the organization of outreach work in general practices during COVID-19. Linear mixed model analyses with practices nested in countries were performed on the data of 4982 practices from 38 countries. A 4-item scale on outreach work was constructed as the outcome variable with a reliability of 0.77 and 0.97 at the practice and country level. The results showed that many practices set up outreach work, including extracting at least one list of patients with chronic conditions from their electronic medical record (30.1%); and performing telephone outreach to patients with chronic conditions (62.8%), a psychological vulnerability (35.6%), or possible situation of domestic violence or a child-rearing situation (17.2%). Outreach work was positively related to the availability of an administrative assistant or practice manager (p < 0.05) or paramedical support staff (p < 0.01). Other practice and country characteristics were not significantly associated with undertaking outreach work. Policy and financial interventions supporting general practices to organize outreach work should focus on the range of personnel available to support such practice activities.
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Affiliation(s)
- Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Claire Collins
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
| | - Peter Groenewegen
- Netherlands Institute for Health Services Research, 3500 BN Utrecht, The Netherlands
- Department of Sociology, Department of Human Geography, Utrecht University, 9000 Ghent, Belgium
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services Research, 3500 BN Utrecht, The Netherlands
| | - Gazmend Bojaj
- Management of Health Institutions and Services, Heimerer College, 10000 Prishtina, Kosovo
| | - Jonila Gabrani
- Faculty of Medicine, University of Basel, 4001 Basel, Switzerland
| | | | - Liubove Murauskiene
- Public Health Department, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | | | - Emmily Schaubroeck
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Stefanie Stark
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen-Nürnberg, Germany
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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25
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Metzner A, Straube F, Tilz RR, Kuniss M, Noelker G, Tebbenjohanns J, Andresen D, Wieneke H, Stellbrink C, Franke J, Dorwarth U, Carion PL, Holbrook R, Hochadel M, Senges J, Hoffmann E, Kuck KH, Garcia-Alberola A, Massa T, Sabin G, Franke A, Souza JJ, Stanley A, Spitzer SG, Willems S, Dierk T, Chun KRJ, Borchard R, Seidl KH, Zahn R, Groschup G, Obel IWP, Brachmann J, Gerds-Li JH, Gopal RR, Schrickel J, Lewalter T, Stanley A, Moshage W, Eckardt L, Jung W, Kremer P, Lubinski A, Schumacher B, Lickfett L, Münzel T, Steinwender C, Efremidis M, Deneke T, Nguyen DQ. Electrophysiology lab efficiency comparison between cryoballoon and point-by-point radiofrequency ablation: a German sub-analysis of the FREEZE Cohort study. BMC Cardiovasc Disord 2023; 23:8. [PMID: 36624380 PMCID: PMC9830778 DOI: 10.1186/s12872-022-03015-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is recommended to treat paroxysmal and persistent atrial fibrillation (AF). This analysis aimed to assess the hospital efficiency of single-shot cryoballoon ablation (CBA) and point-by-point radiofrequency ablation (RFA). METHODS The discrete event simulation used PVI procedure times from the FREEZE Cohort study to establish the electrophysiology (EP) lab occupancy time. 1000 EP lab days were simulated according to an illustrative German hospital, including 3 PVI cases per day using CBA at one site and RFA at the other. RESULTS The analysis included 1560 CBA patients and 1344 RFA patients from the FREEZE Cohort. Some baseline patients' characteristics were different between groups (age, AF type, and some concomitant diseases), without being statistically associated to ablation procedure time. Mean procedure time was 122.2 ± 39.4 min for CBA and 160.3 ± 53.5 min for RFA (p < 0.0001). RFA was associated with a more than five-fold increase of cumulative overtime compared to CBA over the simulated period (1285 h with RFA and 253 h with CBA). 70.7% of RFA lab days included overtime versus 25.7% for CBA. CBA was associated with more days with an additional hour at the end of the EP lab shift compared to RFA (47.8% vs 11.5% days with one hour left, respectively). CONCLUSION CBA is faster and more predictable than point-by-point RFA, and enables improvements in EP lab efficiency, including: fewer cumulative overtime hours, more days where overtime is avoided and more days with remaining time for the staff or for any EP lab usage. Clinical trial registration NCT01360008 (first registration 25/05/2011).
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Affiliation(s)
- Andreas Metzner
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. .,Department of Cardiology, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Gebäude Ost 70, 20246, Hamburg, Germany.
| | - Florian Straube
- grid.419595.50000 0000 8788 1541Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen - Munich Municipal Hospital Group, Munich, Germany
| | - Roland R. Tilz
- grid.459389.a0000 0004 0493 1099Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany ,grid.412468.d0000 0004 0646 2097Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Centre Luebeck, Lübeck, Germany
| | - Malte Kuniss
- grid.419757.90000 0004 0390 5331Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Georg Noelker
- grid.418457.b0000 0001 0723 8327Herz- Und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Juergen Tebbenjohanns
- HELIOS Klinikum Hildesheim, Medizinische Klinik I – Kardiologie, Hildesheim, Germany
| | - Dietrich Andresen
- grid.417953.d0000 0004 0560 5172Department of Cardiology Paul Gerhardt Diakonie gAG, Evangelisches Krankenhaus Hubertus, Berlin, Germany
| | - Heinrich Wieneke
- Klinik Für Kardiologie und Angiologie, Contilia Herz- Und Gefäßzentrum, Essen, Germany
| | - Christoph Stellbrink
- grid.461805.e0000 0000 9323 0964Department of Cardiology, Klinikum Bielefeld, Bielefeld, Germany
| | - Jennifer Franke
- grid.476904.8CardioVascular Center Frankfurt, Frankfurt, Germany
| | - Uwe Dorwarth
- grid.419595.50000 0000 8788 1541Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen - Munich Municipal Hospital Group, Munich, Germany
| | - Phuong Lien Carion
- grid.471158.e0000 0004 0384 6386Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Reece Holbrook
- grid.419673.e0000 0000 9545 2456Medtronic, Inc., Mounds View, MN USA
| | - Matthias Hochadel
- grid.488379.90000 0004 0402 5184Stiftung Institut Fur Herzinfarktforschung, Ludwigshafen, Germany
| | - Jochen Senges
- grid.488379.90000 0004 0402 5184Stiftung Institut Fur Herzinfarktforschung, Ludwigshafen, Germany
| | - Ellen Hoffmann
- grid.419595.50000 0000 8788 1541Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen - Munich Municipal Hospital Group, Munich, Germany
| | - Karl-Heinz Kuck
- grid.459389.a0000 0004 0493 1099Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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Willems S, Brouwers J, Eefting D. Aortic and Iliac Involvement in Brucellosis: a Rare But Life Threatening Manifestation. EJVES Vasc Forum 2023. [DOI: 10.1016/j.ejvsvf.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
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Pecha S, Burger H, Chung DU, Möller V, Madej T, Maali A, Osswald B, De Simone R, Monsefi N, Ziaukas V, Erler S, Perthel M, Wehbe MS, Ghaffari N, Sandhaus T, Busk H, Schmitto JD, Bärsch V, Easo J, Albert M, Treede H, Nägele H, Zenker D, Hegazy Y, Gessler N, Knaut M, Reichenspurner H, Willems S, Butter C, Hakmi S. Safety and Efficacy of Laser Lead Extraction in Octo- and Nonagenarians: A Subgroup Analysis from the GALLERY Registry. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- S. Pecha
- University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland
| | - H. Burger
- Kerckhoff Klinik Bad Nauheim, Bad Nauheim, Deutschland
| | - D. U. Chung
- Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - V. Möller
- Immanuel Herzzentrum Brandenburg, Bernau bei Berlin, Deutschland
| | - T. Madej
- University Hospital Carl Gustav Carus Dresden Heart Center, Dresden, Deutschland
| | - A. Maali
- Herzzentrum, Coswig (Anhalt), Deutschland
| | - B. Osswald
- Johanniter-Krankenhaus Duisburg-Rheinhausen, Duisburg, Deutschland
| | - R. De Simone
- Universitätsklinikum Heidelberg Klinik für Herzchirurgie, Heidelberg, Deutschland
| | - N. Monsefi
- Helios Klinikum Siegburg, Siegburg, Deutschland
| | - V. Ziaukas
- Schüchtermann-Klinik, Bad Rothenfelde, Deutschland
| | - S. Erler
- Department of Cardiothoracic Surgery, Bad Bevensen, Deutschland
| | - M. Perthel
- Heart Centre Bad Segeberg, Bad Segeberg, Deutschland
| | - M. S. Wehbe
- Sana Herzchirurgie Stuttgart GmbH, Stuttgart, Deutschland
| | - N. Ghaffari
- Helios Heart Surgery Clinic Karlsruhe, Karlsruhe, Deutschland
| | | | - H. Busk
- Uniklinik Magdeburg, Magdeburg, Deutschland
| | - J. D. Schmitto
- Medizinische Hochschule Hannover (MHH), Hannover, Deutschland
| | - V. Bärsch
- St. Marien-Krankenhaus Siegen—Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Siegen, Deutschland
| | - J. Easo
- Hospital Oldenburg, Oldenburg, Deutschland
| | - M. Albert
- Robert-Bosch Hospital, Stuttgart, Deutschland
| | - H. Treede
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - H. Nägele
- Albertinen Krankenhaus, Hamburg, Deutschland
| | - D. Zenker
- Robert-Koch-Str. 40, Göttingen, Deutschland
| | - Y. Hegazy
- MediClin Heart Center Lahr/Baden, Lahr/Schwarzwald, Deutschland
| | - N. Gessler
- Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - M. Knaut
- Herzzentrum Dresden Universitätsklinik, Herzchirurgie, Dresden, Deutschland
| | | | - S. Willems
- Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - C. Butter
- Immanuel Herzzentrum Brandenburg, Bernau bei Berlin, Deutschland
| | - S. Hakmi
- Asklepios Klinik St. Georg, Hamburg, Deutschland
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Stark S, Kluge M, Schaubroeck E, Werner F, van Poel E, Willems S, Roos M, Kühlein T, Burggraf L. "What else to say?"-Primary health care in times of COVID-19 from the perspective of German general practitioners: An exploratory analysis of the open text field in the PRICOV-19 study. PLoS One 2023; 18:e0282504. [PMID: 36930662 PMCID: PMC10022805 DOI: 10.1371/journal.pone.0282504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 02/16/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The international collaboration study PRICOV-19 -Primary Health Care in times of COVID-19 aims to assess the impact of the COVID-19 pandemic on the organisation of primary health care. The German part focuses on the subjective perceptions of general practitioners on primary health care and the impact of political measures during the second wave of the COVID-19 pandemic. Within this survey, the "open text field" of the questionnaire was utilised remarkably frequently and extensively by the respondents. It became clear that the content that was named needed to be analysed in an exploratory manner. Accordingly, this paper addresses the following question: What preoccupies general practitioners in Germany during COVID-19 that we have not yet asked them enough? METHODS The data collection took place throughout Germany from 01.02.2021 to 28.02.2021with a quantitative online questionnaire consisting of 53 items arranged across six topics as well as an "open text field" for further comments. The questionnaire's open text field was analysed following the premises of the qualitative content analysis. RESULTS The topics discussed by the respondents were: insufficient support from health policies, not being prioritised and involved in the vaccination strategy, feeling insufficient prepared, that infrastructural changes and financial concerns threatened the practice, and perceiving the own role as important, as well as that health policies affected the wellbeing of the respondents. One of the main points was the way general practitioners were not sufficiently acknowledged for their contribution to ensuring high-quality care during the pandemic. DISCUSSION German general practitioners perceived their work and role as highly relevant during the COVID-19 pandemic. In controversy with their perception, they described political conditions in which they were the ones who contributed significantly to the fight against the pandemic but were not given enough recognition.
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Affiliation(s)
- Stefanie Stark
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- * E-mail:
| | - Marie Kluge
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Emmily Schaubroeck
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Felix Werner
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Esther van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Marco Roos
- General Practice, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Thomas Kühlein
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Larissa Burggraf
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Nessler K, Van Poel E, Willems S, Wójtowicz E, Mann MR, Windak A. The response of primary care practices in rural and urban settings in Poland to the challenges of the COVID-19 pandemic. Ann Agric Environ Med 2022; 29:575-581. [PMID: 36583326 DOI: 10.26444/aaem/155906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
INTRODUCTION In the wake of COVID-19 primary care practices have had to overcome and to adapt to several challenges in providing quality care. An international consortium led by Ghent University, Belgium, set up the PRICOV-19 project to study how primary care practices in 38 countries responded to the new challenges. OBJECTIVE The aim of the study was to describe how Covid-19 impacted the organisation of primary care practices in rural and urban environments in Poland, including the organisation of patient flows, infection prevention, information processing, and communication. MATERIAL AND METHODS This is cross-sectional questionnaire-based survey among primary care practices. In Poland, the survey was distributed among primary care practices in 16 Polish regions. 180 practices participated in the study. In the analysis of the data U-Mann Whitney or t-test for independent groups, and Wilcoxon test were used to compare the organisation of care before and since the pandemic. RESULTS Over two-thirds of practices made considerable changes in their structure due to COVID-19; over three-quarters introduced security procedures for phone registrations, but only a quarter still offered consultations without a prior appointment. The use of video consultation quadrupled, and teleconsultations became almost universal. Rural practices were significantly more likely to offer active care for deprived patient groups. A significant increase in infection prevention measures occurred in both urban and rural practices. CONCLUSIONS COVID-19 brought challenges that spurred changes to the organisation of primary care practices as they sought to continue offering quality care. Despite these hardships, new opportunities for effective changes to clinical operations and organization have emerged and will benefit global health systems in the face of new crises.
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Affiliation(s)
- Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Ewa Wójtowicz
- Department of Family Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Mitchell R Mann
- Department of Family Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, Kraków, Poland
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Windak A, Nessler K, Van Poel E, Collins C, Wójtowicz E, Murauskiene L, Hoffmann K, Willems S. Responding to COVID-19: The Suitability of Primary Care Infrastructure in 33 Countries. Int J Environ Res Public Health 2022; 19:17015. [PMID: 36554901 PMCID: PMC9779330 DOI: 10.3390/ijerph192417015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
COVID-19 proved that primary care (PC) providers have an important role in managing health emergencies, such as epidemics. Little is known about the preparedness of primary care practice infrastructure to continue providing high quality care during this crisis. The aim of this paper is to describe the perceived limitations to the infrastructure of PC practices during COVID-19 and to determine the factors associated with a higher likelihood of infrastructural barriers in providing high quality care. This paper presents the results of an online survey conducted between November 2020 and November 2021 as a part of PRICOV-19 study. Data from 4974 practices in 33 countries regarding perceived limitations and intentions to make future adjustments to practice infrastructure as a result of the COVID-19 pandemic were collected. Approximately 58% of practices experienced limitations to the building or other practice infrastructure to provide high-quality and safe care during the COVID-19 pandemic, and in 54% making adjustments to the building or the infrastructure was considered. Large variations between the countries were found. The results show that infrastructure constraints were directly proportional to the size of the practice. Better pandemic infection control equipment, governmental support, and a fee-for-service payment system were found to be associated with a lower perceived need for infrastructural changes. The results of the study indicate the need for systematic support for the development of practice infrastructure in order to provide high-quality, safe primary care in the event of future crises similar to the COVID-19 pandemic.
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Affiliation(s)
- Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, 31-061 Krakow, Poland
| | - Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, 31-061 Krakow, Poland
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Claire Collins
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
| | - Ewa Wójtowicz
- Department of Family Medicine, Jagiellonian University Medical College, 31-061 Krakow, Poland
| | - Liubove Murauskiene
- Public Health Department, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Kathryn Hoffmann
- Unit Health Services Research and Telemedicine in Primary Care, Department of Preventive- and Social Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090 Wien, Austria
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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Groenewegen P, Van Poel E, Spreeuwenberg P, Batenburg R, Mallen C, Murauskiene L, Peris A, Pétré B, Schaubroeck E, Stark S, Sigurdsson EL, Tatsioni A, Vafeidou K, Willems S. Has the COVID-19 Pandemic Led to Changes in the Tasks of the Primary Care Workforce? An International Survey among General Practices in 38 Countries (PRICOV-19). Int J Environ Res Public Health 2022; 19:15329. [PMID: 36430047 PMCID: PMC9690243 DOI: 10.3390/ijerph192215329] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic has had a large and varying impact on primary care. This paper studies changes in the tasks of general practitioners (GPs) and associated staff during the COVID-19 pandemic. Data from the PRICOV-19 study of 5093 GPs in 38 countries were used. We constructed a scale for task changes and performed multilevel analyses. The scale was reliable at both GP and country level. Clustering of task changes at country level was considerable (25%). During the pandemic, staff members were more involved in giving information and recommendations to patients contacting the practice by phone, and they were more involved in triage. GPs took on additional responsibilities and were more involved in reaching out to patients. Problems due to staff absence, when dealt with internally, were related to more task changes. Task changes were larger in practices employing a wider range of professional groups. Whilst GPs were happy with the task changes in practices with more changes, they also felt the need for further training. A higher-than-average proportion of elderly people and people with a chronic condition in the practice were related to task changes. The number of infections in a country during the first wave of the pandemic was related to task changes. Other characteristics at country level were not associated with task changes. Future research on the sustainability of task changes after the pandemic is needed.
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Affiliation(s)
- Peter Groenewegen
- Netherlands Institute for Health Services Research (NIVEL), 3500 BN Utrecht, The Netherlands
- Department of Sociology, Utrecht University, 3584 CS Utrecht, The Netherlands
- Department of Human Geography, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services Research (NIVEL), 3500 BN Utrecht, The Netherlands
| | - Ronald Batenburg
- Netherlands Institute for Health Services Research (NIVEL), 3500 BN Utrecht, The Netherlands
- Department of Sociology, Radboud University, 6535 XN Nijmegen, The Netherlands
| | | | - Liubove Murauskiene
- Department of Public Health, Faculty of Medicine, University of Vilnius, 03101 Vilnius, Lithuania
| | - Antoni Peris
- Castelldefels Agents de Salut (Casap), 08860 Castelldefels, Spain
| | - Benoit Pétré
- Department of Public Health, Faculty of Medicine, University of Liège, 4000 Liège, Belgium
| | - Emmily Schaubroeck
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlan-gen-Nürnberg, Germany
| | - Stefanie Stark
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlan-gen-Nürnberg, Germany
| | - Emil L. Sigurdsson
- Department of family medicine, University of Iceland, 102 Reykjavík, Iceland
| | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, 45110 Ioannina, Greece
| | - Kyriaki Vafeidou
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, 45110 Ioannina, Greece
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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Gunawardene MA, Lemoine M, Deneke T, Wakili R, Steven D, Schaeffer B, Rillig A, Nentwich K, Siebermair J, Filipovic K, Simu G, Riesinger L, Sultan A, Willems S, Metzner A. Pulsed field ablation for atrial fibrillation: acute procedural efficacy and safety of an initial German multicenter experience. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pulsed field ablation (PFA) is a novel non-thermal energy source to conduct catheter ablation of atrial fibrillation (AF). However, real-world multi-center data regarding acute procedural efficacy and safety is sparse.
Purpose
To study acute procedural success and safety in patients undergoing PFA for catheter ablation of AF in a multicenter registry.
Methods
Consecutive paroxysmal and persistent AF patients undergoing PFA-based catheter ablation using a multispline catheter were enrolled. The cohort included first and repeat ablation procedures. Procedural parameters, acute success and in-hospital safety were evaluated. A follow-up of all patients was conducted.
Results
Five German centers enrolled a total of 154 patients undergoing PFA in this study. Mean age was 68±12 years, median CHA2DS2-VASc Score was 3 (Q1-Q3: 2–4).
Patients suffered from paroxysmal AF (n=55; 36%), persistent AF (n=93; 60%) and consecutive atrial tachycardias (AT) due to previous CA (n=6; 4%).
The median left atrial (LA) PFA and total procedure times were 33 (Q1-Q3: 24–53) and 90 (Q1-Q3: 73–116) minutes, respectively. Mean LA PFA fluoroscopy and total fluoroscopy times were 12.1±5.5 and 20.2±8.7 minutes. Of all 154 procedures, 130 (84%) were index ablation procedures with isolation of pulmonary veins (PVI) only and 24 (16%) were repeat procedures (including re-PVI and ablation of consecutive AT).
Acute PV reconnection following primary PVI and the initial set of PFA-applications was found in 20/130 (15%) patients, necessitating additional PFA ablation. Finally, successful PFA-guided PVI was achieved in all patients.
Additional PFA lesion sets (including LA posterior wall isolation, anterior ablation, mitral isthmus ablation) were applied in 17/154 (11%) patients.
Complications occurred in a total of 6/154 (3.8%) patients (including three groin site complications, two pericardial tamponades, one transient coronary spasm without sequela). The follow up data is still being assessed and will be provided by the time of the ESC 2022 meeting.
Conclusion
PFA performed in patients with atrial fibrillation demonstrates high acute procedural success rates and a favorable safety profile in this first real-world multicenter registry.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - M Lemoine
- The University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - T Deneke
- Heart Center Bad Neustadt , Bad Neustadt a. d. Saale , Germany
| | - R Wakili
- University hospital Essen , Essen , Germany
| | - D Steven
- University of Cologne , Cologne , Germany
| | - B Schaeffer
- Asklepios Clinic St. Georg , Hamburg , Germany
| | - A Rillig
- The University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - K Nentwich
- Heart Center Bad Neustadt , Bad Neustadt a. d. Saale , Germany
| | | | | | - G Simu
- Heart Center Bad Neustadt , Bad Neustadt a. d. Saale , Germany
| | | | - A Sultan
- University of Cologne , Cologne , Germany
| | - S Willems
- Asklepios Clinic St. Georg , Hamburg , Germany
| | - A Metzner
- The University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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Wahedi R, Willems S, Jularic M, Hartmann J, Schaeffer B, Akbulak-Stegli Ö, Eickholt C, Anwar O, Maurer T, Hedenus K, Gunawardene M. Safety and efficacy of catheter ablation for atrial fibrillation in the very elderly. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The incidence and prevalence of atrial fibrillation (AF) increases with age. With an ageing general population, a 2.3-fold rise in AF prevalence is expected. Catheter ablation has emerged as an effective treatment option for rhythm control therapy. However, very elderly patients (≥80 years old) have been excluded in landmark clinical trials. Current data regarding the safety and efficacy of catheter ablation in the very elderly is therefore sparse.
Purpose
Due to the growing demand to manage AF in an increasingly ageing population, we investigated the safety and efficacy of catheter ablation in this particular patient population.
Methods
Patients with symptomatic paroxysmal, persistent and long-standing persistent AF aged ≥80 years undergoing catheter ablation, including first and re-ablation procedures in a single centre, were analysed retrospectively. Catheter ablation involved pulmonary vein isolation (PVI) using radiofrequency, cryoballoon and pulsed field ablation as energy sources. Re-ablation procedures included re-PVI and consecutive atrial tachycardia ablation including atrial lines and/or ablation of complex fractionated atrial electrograms (CFAE) in persistent AF. Endpoints included acute procedural success (complete isolation of pulmonary veins and/or non-inducibility in the case of atrial tachycardia), major complications and early arrhythmia-recurrence.
Results
A total of eighty-eight patients (mean age 83.1±1.9 years, mean CHA2DS2-VASc-Score 4.4±1, mean left ventricular ejection fraction 56.7±7%, direct oral anticoagulation 92.1%, vitamin-K antagonists 7.9%) were included from January 2021 to October 2021. Fifty cases (56.8%) involved PVI as an index procedure (radiofrequency 58%, n=29/50, cryoballoon 36%, n=18/50, pulsed field ablation 6%, n=3/50). Thirty-eight procedures (43.2%) involved re-ablation procedures (Re-PVI 60.5%, n=23/38, linear lesions 65.8%, n=25/38, atrial tachycardia ablation 26.3%, n=10/38 and ablation of CFAE 15.8%, n=6/38). Acute procedural success was achieved in 87/88 patients (98.9%). Major complications included stroke (n=1/88, 1.1%), pericardial tamponade (n=1/88, 1.1%) and bradycardia with subsequent pacemaker implantation (n=3/88, 3.4%). No further major complications were documented. In 13/88 patients (14.8%) early arrhythmia-recurrence occurred (38.5%, n=5/13 after the index procedure and 61.5%, n=8/13 after re-ablation) during the 90-day blanking period.
Conclusions
Catheter ablation for atrial fibrillation in the very elderly shows favourable acute success and low complication rates. Long term success of catheter ablation and superiority to rate control in this patient population is unknown and requires investigation in the future.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Wahedi
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - S Willems
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - M Jularic
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - J Hartmann
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - B Schaeffer
- Asklepios St. Georg Clinic , Hamburg , Germany
| | | | - C Eickholt
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - O Anwar
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - T Maurer
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - K Hedenus
- Asklepios St. Georg Clinic , Hamburg , Germany
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Adler L, Vinker S, Heymann AD, Van Poel E, Willems S, Zacay G. The effect of the COVID-19 pandemic on primary care physicians in Israel, with comparison to an international cohort: a cross-sectional study. Isr J Health Policy Res 2022; 11:34. [PMID: 36127744 PMCID: PMC9486777 DOI: 10.1186/s13584-022-00543-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic had a major impact on primary care and primary care physicians (PCPs) in Israel and around the world. There is paucity of information regarding treatment of patients with COVID-19 in the community, since most research was performed in hospitals. The aim of this study was to describe the Israeli PCPs' experience. METHODS This study is a part of an international cross-sectional study, the PRICOV-19. A translated version of the questionnaire was distributed among Israeli PCPs from December 2020 to July 2021. In this study, we describe the Israeli results and compare them to the international results. RESULTS 5,961 respondents from 29 countries answered the questionnaire, 94 from Israel, with an Israeli response rate of 16%. Israeli PCPs reported an increase in use of telemedicine from 11 to 49% during the COVID epidemic. PCPs also reported a decline in their wellbeing; absence of secured time slots for keeping updated; perception that the Ministry of Health guidelines were a threat to the staff wellbeing and organization of practice and delays in the examination of non-COVID urgent cases. CONCLUSIONS The findings of this study raise concerns regarding the PCPs experience and may form the basis for an improved process of care. Guidelines for proper usage of telemedicine, substitutes for the physical examination and procedures for minimizing delayed patient examination for urgent conditions should be developed. Government directives and clinical guidelines should be communicated in a timely manner, with secured timeslots for physicians' self-learning or updating. Ensuring physicians' well-being in general should be an organization priority.
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Affiliation(s)
- Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel. .,Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Headquarters, Medical Division, Leumit Healthcare Services, Tel Aviv, Israel
| | - Anthony D Heymann
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Meuhedet Healthcare Maintenance Organization, Tel Aviv, Israel
| | - 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
| | - 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
| | - Galia Zacay
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Meuhedet Healthcare Maintenance Organization, Tel Aviv, Israel
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Dinter R, Willems S, Hachem M, Mittelstädt M, Brunschweiger A, Kockmann N. Two‐Phase Flow Reaction System for Amide Coupling Towards Automated DNA‐Encoded Chemistry. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- R. Dinter
- TU Dortmund University Department of Chemical and Biochemical Engineering, Laboratory of Equipment Design Emil-Figge-Str. 68 44227 Dortmund Germany
| | - S. Willems
- TU Dortmund University Department of Chemistry and Chemical Biology, Medicinal Chemistry Otto-Hahn-Str. 6 44227 Dortmund Germany
| | - M. Hachem
- TU Dortmund University Department of Chemical and Biochemical Engineering, Laboratory of Equipment Design Emil-Figge-Str. 68 44227 Dortmund Germany
| | - M. Mittelstädt
- TU Dortmund University Department of Chemical and Biochemical Engineering, Laboratory of Equipment Design Emil-Figge-Str. 68 44227 Dortmund Germany
| | - A. Brunschweiger
- TU Dortmund University Department of Chemistry and Chemical Biology, Medicinal Chemistry Otto-Hahn-Str. 6 44227 Dortmund Germany
| | - N. Kockmann
- TU Dortmund University Department of Chemical and Biochemical Engineering, Laboratory of Equipment Design Emil-Figge-Str. 68 44227 Dortmund Germany
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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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Proietti M, Romiti GF, Vitolo M, Harrison SL, Lane DA, Fauchier L, Marin F, Näbauer M, Potpara TS, Dan GA, Maggioni AP, Cesari M, Boriani G, Lip GYH, Ekmekçiu U, Paparisto V, Tase M, Gjergo H, Dragoti J, Goda A, Ciutea M, Ahadi N, el Husseini Z, Raepers M, Leroy J, Haushan P, Jourdan A, Lepiece C, Desteghe L, Vijgen J, Koopman P, Van Genechten G, Heidbuchel H, Boussy T, De Coninck M, Van Eeckhoutte H, Bouckaert N, Friart A, Boreux J, Arend C, Evrard P, Stefan L, Hoffer E, Herzet J, Massoz M, Celentano C, Sprynger M, Pierard L, Melon P, Van Hauwaert B, Kuppens C, Faes D, Van Lier D, Van Dorpe A, Gerardy A, Deceuninck O, Xhaet O, Dormal F, Ballant E, Blommaert D, Yakova D, Hristov M, Yncheva T, Stancheva N, Tisheva S, Tokmakova M, Nikolov F, Gencheva D, Shalganov T, Kunev B, Stoyanov M, Marchov D, Gelev V, Traykov V, Kisheva A, Tsvyatkov H, Shtereva R, Bakalska-Georgieva S, Slavcheva S, Yotov Y, Kubíčková M, Marni Joensen A, Gammelmark A, Hvilsted Rasmussen L, Dinesen P, Riahi S, Krogh Venø S, Sorensen B, Korsgaard A, Andersen K, Fragtrup Hellum C, Svenningsen A, Nyvad O, Wiggers P, May O, Aarup A, Graversen B, Jensen L, Andersen M, Svejgaard M, Vester S, Hansen S, Lynggaard V, Ciudad M, Vettus R, Muda P, Maestre A, Castaño S, Cheggour S, Poulard J, Mouquet V, Leparrée S, Bouet J, Taieb J, Doucy A, Duquenne H, Furber A, Dupuis J, Rautureau J, Font M, Damiano P, Lacrimini M, Abalea J, Boismal S, Menez T, Mansourati J, Range G, Gorka H, Laure C, Vassalière C, Elbaz N, Lellouche N, Djouadi K, Roubille F, Dietz D, Davy J, Granier M, Winum P, Leperchois-Jacquey C, Kassim H, Marijon E, Le Heuzey J, Fedida J, Maupain C, Himbert C, Gandjbakhch E, Hidden-Lucet F, Duthoit G, Badenco N, Chastre T, Waintraub X, Oudihat M, Lacoste J, Stephan C, Bader H, Delarche N, Giry L, Arnaud D, Lopez C, Boury F, Brunello I, Lefèvre M, Mingam R, Haissaguerre M, Le Bidan M, Pavin D, Le Moal V, Leclercq C, Piot O, Beitar T, Martel I, Schmid A, Sadki N, Romeyer-Bouchard C, Da Costa A, Arnault I, Boyer M, Piat C, Fauchier L, Lozance N, Nastevska S, Doneva A, Fortomaroska Milevska B, Sheshoski B, Petroska K, Taneska N, Bakrecheski N, Lazarovska K, Jovevska S, Ristovski V, Antovski A, Lazarova E, Kotlar I, Taleski J, Poposka L, Kedev S, Zlatanovik N, Jordanova S, Bajraktarova Proseva T, Doncovska S, Maisuradze D, Esakia A, Sagirashvili E, Lartsuliani K, Natelashvili N, Gumberidze N, Gvenetadze R, Etsadashvili K, Gotonelia N, Kuridze N, Papiashvili G, Menabde I, Glöggler S, Napp A, Lebherz C, Romero H, Schmitz K, Berger M, Zink M, Köster S, Sachse J, Vonderhagen E, Soiron G, Mischke K, Reith R, Schneider M, Rieker W, Boscher D, Taschareck A, Beer A, Oster D, Ritter O, Adamczewski J, Walter S, Frommhold A, Luckner E, Richter J, Schellner M, Landgraf S, Bartholome S, Naumann R, Schoeler J, Westermeier D, William F, Wilhelm K, Maerkl M, Oekinghaus R, Denart M, Kriete M, Tebbe U, Scheibner T, Gruber M, Gerlach A, Beckendorf C, Anneken L, Arnold M, Lengerer S, Bal Z, Uecker C, Förtsch H, Fechner S, Mages V, Martens E, Methe H, Schmidt T, Schaeffer B, Hoffmann B, Moser J, Heitmann K, Willems S, Willems S, Klaus C, Lange I, Durak M, Esen E, Mibach F, Mibach H, Utech A, Gabelmann M, Stumm R, Ländle V, Gartner C, Goerg C, Kaul N, Messer S, Burkhardt D, Sander C, Orthen R, Kaes S, Baumer A, Dodos F, Barth A, Schaeffer G, Gaertner J, Winkler J, Fahrig A, Aring J, Wenzel I, Steiner S, Kliesch A, Kratz E, Winter K, Schneider P, Haag A, Mutscher I, Bosch R, Taggeselle J, Meixner S, Schnabel A, Shamalla A, Hötz H, Korinth A, Rheinert C, Mehltretter G, Schön B, Schön N, Starflinger A, Englmann E, Baytok G, Laschinger T, Ritscher G, Gerth A, Dechering D, Eckardt L, Kuhlmann M, Proskynitopoulos N, Brunn J, Foth K, Axthelm C, Hohensee H, Eberhard K, Turbanisch S, Hassler N, Koestler A, Stenzel G, Kschiwan D, Schwefer M, Neiner S, Hettwer S, Haeussler-Schuchardt M, Degenhardt R, Sennhenn S, Steiner S, Brendel M, Stoehr A, Widjaja W, Loehndorf S, Logemann A, Hoskamp J, Grundt J, Block M, Ulrych R, Reithmeier A, Panagopoulos V, Martignani C, Bernucci D, Fantecchi E, Diemberger I, Ziacchi M, Biffi M, Cimaglia P, Frisoni J, Boriani G, Giannini I, Boni S, Fumagalli S, Pupo S, Di Chiara A, Mirone P, Fantecchi E, Boriani G, Pesce F, Zoccali C, Malavasi VL, Mussagaliyeva A, Ahyt B, Salihova Z, Koshum-Bayeva K, Kerimkulova A, Bairamukova A, Mirrakhimov E, Lurina B, Zuzans R, Jegere S, Mintale I, Kupics K, Jubele K, Erglis A, Kalejs O, Vanhear K, Burg M, Cachia M, Abela E, Warwicker S, Tabone T, Xuereb R, Asanovic D, Drakalovic D, Vukmirovic M, Pavlovic N, Music L, Bulatovic N, Boskovic A, Uiterwaal H, Bijsterveld N, De Groot J, Neefs J, van den Berg N, Piersma F, Wilde A, Hagens V, Van Es J, Van Opstal J, Van Rennes B, Verheij H, Breukers W, Tjeerdsma G, Nijmeijer R, Wegink D, Binnema R, Said S, Erküner Ö, Philippens S, van Doorn W, Crijns H, Szili-Torok T, Bhagwandien R, Janse P, Muskens A, van Eck M, Gevers R, van der Ven N, Duygun A, Rahel B, Meeder J, Vold A, Holst Hansen C, Engset I, Atar D, Dyduch-Fejklowicz B, Koba E, Cichocka M, Sokal A, Kubicius A, Pruchniewicz E, Kowalik-Sztylc A, Czapla W, Mróz I, Kozlowski M, Pawlowski T, Tendera M, Winiarska-Filipek A, Fidyk A, Slowikowski A, Haberka M, Lachor-Broda M, Biedron M, Gasior Z, Kołodziej M, Janion M, Gorczyca-Michta I, Wozakowska-Kaplon B, Stasiak M, Jakubowski P, Ciurus T, Drozdz J, Simiera M, Zajac P, Wcislo T, Zycinski P, Kasprzak J, Olejnik A, Harc-Dyl E, Miarka J, Pasieka M, Ziemińska-Łuć M, Bujak W, Śliwiński A, Grech A, Morka J, Petrykowska K, Prasał M, Hordyński G, Feusette P, Lipski P, Wester A, Streb W, Romanek J, Woźniak P, Chlebuś M, Szafarz P, Stanik W, Zakrzewski M, Kaźmierczak J, Przybylska A, Skorek E, Błaszczyk H, Stępień M, Szabowski S, Krysiak W, Szymańska M, Karasiński J, Blicharz J, Skura M, Hałas K, Michalczyk L, Orski Z, Krzyżanowski K, Skrobowski A, Zieliński L, Tomaszewska-Kiecana M, Dłużniewski M, Kiliszek M, Peller M, Budnik M, Balsam P, Opolski G, Tymińska A, Ozierański K, Wancerz A, Borowiec A, Majos E, Dabrowski R, Szwed H, Musialik-Lydka A, Leopold-Jadczyk A, Jedrzejczyk-Patej E, Koziel M, Lenarczyk R, Mazurek M, Kalarus Z, Krzemien-Wolska K, Starosta P, Nowalany-Kozielska E, Orzechowska A, Szpot M, Staszel M, Almeida S, Pereira H, Brandão Alves L, Miranda R, Ribeiro L, Costa F, Morgado F, Carmo P, Galvao Santos P, Bernardo R, Adragão P, Ferreira da Silva G, Peres M, Alves M, Leal M, Cordeiro A, Magalhães P, Fontes P, Leão S, Delgado A, Costa A, Marmelo B, Rodrigues B, Moreira D, Santos J, Santos L, Terchet A, Darabantiu D, Mercea S, Turcin Halka V, Pop Moldovan A, Gabor A, Doka B, Catanescu G, Rus H, Oboroceanu L, Bobescu E, Popescu R, Dan A, Buzea A, Daha I, Dan G, Neuhoff I, Baluta M, Ploesteanu R, Dumitrache N, Vintila M, Daraban A, Japie C, Badila E, Tewelde H, Hostiuc M, Frunza S, Tintea E, Bartos D, Ciobanu A, Popescu I, Toma N, Gherghinescu C, Cretu D, Patrascu N, Stoicescu C, Udroiu C, Bicescu G, Vintila V, Vinereanu D, Cinteza M, Rimbas R, Grecu M, Cozma A, Boros F, Ille M, Tica O, Tor R, Corina A, Jeewooth A, Maria B, Georgiana C, Natalia C, Alin D, Dinu-Andrei D, Livia M, Daniela R, Larisa R, Umaar S, Tamara T, Ioachim Popescu M, Nistor D, Sus I, Coborosanu O, Alina-Ramona N, Dan R, Petrescu L, Ionescu G, Popescu I, Vacarescu C, Goanta E, Mangea M, Ionac A, Mornos C, Cozma D, Pescariu S, Solodovnicova E, Soldatova I, Shutova J, Tjuleneva L, Zubova T, Uskov V, Obukhov D, Rusanova G, Soldatova I, Isakova N, Odinsova S, Arhipova T, Kazakevich E, Serdechnaya E, Zavyalova O, Novikova T, Riabaia I, Zhigalov S, Drozdova E, Luchkina I, Monogarova Y, Hegya D, Rodionova L, Rodionova L, Nevzorova V, Soldatova I, Lusanova O, Arandjelovic A, Toncev D, Milanov M, Sekularac N, Zdravkovic M, Hinic S, Dimkovic S, Acimovic T, Saric J, Polovina M, Potpara T, Vujisic-Tesic B, Nedeljkovic M, Zlatar M, Asanin M, Vasic V, Popovic Z, Djikic D, Sipic M, Peric V, Dejanovic B, Milosevic N, Stevanovic A, Andric A, Pencic B, Pavlovic-Kleut M, Celic V, Pavlovic M, Petrovic M, Vuleta M, Petrovic N, Simovic S, Savovic Z, Milanov S, Davidovic G, Iric-Cupic V, Simonovic D, Stojanovic M, Stojanovic S, Mitic V, Ilic V, Petrovic D, Deljanin Ilic M, Ilic S, Stoickov V, Markovic S, Kovacevic S, García Fernandez A, Perez Cabeza A, Anguita M, Tercedor Sanchez L, Mau E, Loayssa J, Ayarra M, Carpintero M, Roldán Rabadan I, Leal M, Gil Ortega M, Tello Montoliu A, Orenes Piñero E, Manzano Fernández S, Marín F, Romero Aniorte A, Veliz Martínez A, Quintana Giner M, Ballesteros G, Palacio M, Alcalde O, García-Bolao I, Bertomeu Gonzalez V, Otero-Raviña F, García Seara J, Gonzalez Juanatey J, Dayal N, Maziarski P, Gentil-Baron P, Shah D, Koç M, Onrat E, Dural IE, Yilmaz K, Özin B, Tan Kurklu S, Atmaca Y, Canpolat U, Tokgozoglu L, Dolu AK, Demirtas B, Sahin D, Ozcan Celebi O, Diker E, Gagirci G, Turk UO, Ari H, Polat N, Toprak N, Sucu M, Akin Serdar O, Taha Alper A, Kepez A, Yuksel Y, Uzunselvi A, Yuksel S, Sahin M, Kayapinar O, Ozcan T, Kaya H, Yilmaz MB, Kutlu M, Demir M, Gibbs C, Kaminskiene S, Bryce M, Skinner A, Belcher G, Hunt J, Stancombe L, Holbrook B, Peters C, Tettersell S, Shantsila A, Lane D, Senoo K, Proietti M, Russell K, Domingos P, Hussain S, Partridge J, Haynes R, Bahadur S, Brown R, McMahon S, Y H Lip G, McDonald J, Balachandran K, Singh R, Garg S, Desai H, Davies K, Goddard W, Galasko G, Rahman I, Chua Y, Payne O, Preston S, Brennan O, Pedley L, Whiteside C, Dickinson C, Brown J, Jones K, Benham L, Brady R, Buchanan L, Ashton A, Crowther H, Fairlamb H, Thornthwaite S, Relph C, McSkeane A, Poultney U, Kelsall N, Rice P, Wilson T, Wrigley M, Kaba R, Patel T, Young E, Law J, Runnett C, Thomas H, McKie H, Fuller J, Pick S, Sharp A, Hunt A, Thorpe K, Hardman C, Cusack E, Adams L, Hough M, Keenan S, Bowring A, Watts J, Zaman J, Goffin K, Nutt H, Beerachee Y, Featherstone J, Mills C, Pearson J, Stephenson L, Grant S, Wilson A, Hawksworth C, Alam I, Robinson M, Ryan S, Egdell R, Gibson E, Holland M, Leonard D, Mishra B, Ahmad S, Randall H, Hill J, Reid L, George M, McKinley S, Brockway L, Milligan W, Sobolewska J, Muir J, Tuckis L, Winstanley L, Jacob P, Kaye S, Morby L, Jan A, Sewell T, Boos C, Wadams B, Cope C, Jefferey P, Andrews N, Getty A, Suttling A, Turner C, Hudson K, Austin R, Howe S, Iqbal R, Gandhi N, Brophy K, Mirza P, Willard E, Collins S, Ndlovu N, Subkovas E, Karthikeyan V, Waggett L, Wood A, Bolger A, Stockport J, Evans L, Harman E, Starling J, Williams L, Saul V, Sinha M, Bell L, Tudgay S, Kemp S, Brown J, Frost L, Ingram T, Loughlin A, Adams C, Adams M, Hurford F, Owen C, Miller C, Donaldson D, Tivenan H, Button H, Nasser A, Jhagra O, Stidolph B, Brown C, Livingstone C, Duffy M, Madgwick P, Roberts P, Greenwood E, Fletcher L, Beveridge M, Earles S, McKenzie D, Beacock D, Dayer M, Seddon M, Greenwell D, Luxton F, Venn F, Mills H, Rewbury J, James K, Roberts K, Tonks L, Felmeden D, Taggu W, Summerhayes A, Hughes D, Sutton J, Felmeden L, Khan M, Walker E, Norris L, O’Donohoe L, Mozid A, Dymond H, Lloyd-Jones H, Saunders G, Simmons D, Coles D, Cotterill D, Beech S, Kidd S, Wrigley B, Petkar S, Smallwood A, Jones R, Radford E, Milgate S, Metherell S, Cottam V, Buckley C, Broadley A, Wood D, Allison J, Rennie K, Balian L, Howard L, Pippard L, Board S, Pitt-Kerby T. Epidemiology and impact of frailty in patients with atrial fibrillation in Europe. Age Ageing 2022; 51:6670566. [PMID: 35997262 DOI: 10.1093/ageing/afac192] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. OBJECTIVES We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. METHODS A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. RESULTS Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. CONCLUSIONS In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
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Affiliation(s)
- Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Francisco Marin
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV, Murcia, Spain
| | - Michael Näbauer
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Center of Serbia, Belgrade, Serbia
| | - Gheorghe-Andrei Dan
- University of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Groenewegen PP, Spreeuwenberg P, Siriwardena AN, Sirdifield C, Willems S. Migrant GPs and patients: a cross-sectional study of practice characteristics, patient experiences and migration concordance. Scand J Prim Health Care 2022; 40:181-189. [PMID: 35575141 PMCID: PMC9397456 DOI: 10.1080/02813432.2022.2069719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To investigate practice type and location of native and immigrant general practitioners (GPs); effects of migration status concordance between GPs and patients on experiences of patients in key areas of primary care quality and discrimination. DESIGN AND SETTING Secondary analysis of GP and patient survey data from QUALICOPC (Quality and Costs of Primary Care), a cross-sectional study of GPs and their patients in 34 countries, performed between 2011 and 2013. MAIN OUTCOME MEASURES We explored practice type and location of native and immigrant GPs and the experiences of native patients and patients with a migration background of communication, continuity, comprehensiveness, accessibility, and discrimination, using multilevel analysis. Concordance was modelled as a cross-level interaction between migration status of GPs and patients. RESULTS Percentages of immigrant GPs varied widely. In Europe, this was highest in England and Luxemburg (40% of GPs born abroad) and lowest in Bulgaria and Romania (1%). The practice population of immigrant GPs more often included an above average proportion of people from ethnic minorities. There were no differences in main effects of patient experiences following a visit to an immigrant or native GP, in four core areas of primary care or in discrimination. However, people from first-generation migrant background more often experienced discrimination, in particular when visiting a native GP. CONCLUSION Patient experiences did not vary with GPs' migration status. Although experience of discrimination was uncommon, first-generation migrant patients experienced more discrimination. Primary care should provide non-discriminatory care, through GP awareness of unconscious bias and training to address this. Key messagesThere were large differences in percentage of migrant GPs between countries.Migrant GPs' practices had an above average proportion of people from ethnic minorities.In general, patients' experienced discrimination from GPs and practice staff was low, but first-generation migrant patients more often experienced discrimination.First-generation migrant patients more often experienced discrimination when they visited a native GP.
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Affiliation(s)
- Peter P. Groenewegen
- Nivel, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of Sociology and Department of Human Geography, Utrecht University, Utrecht, The Netherlands
- CONTACT Peter P. Groenewegen Nivel, PO Box 1568, Utrecht, 3500, BN, The Netherlands
| | - Peter Spreeuwenberg
- Nivel, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - A. Niroshan Siriwardena
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Coral Sirdifield
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
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39
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Obergassel J, Taraba S, Nies M, Atzor C, Lemoine MD, Rottner L, Schleberger R, Dinshaw LWH, Meyer C, Willems S, Reissmann B, Ouyang F, Metzner A, Kirchhof P, Rillig A. Why are redo AF ablations required and what does it take? Type of index PVI predicts pattern of redo ablations. Europace 2022. [DOI: 10.1093/europace/euac053.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Catheter ablation targeting isolation of the pulmonary veins (PVI) is the most effective treatment for atrial fibrillation (AF). Despite its high overall effectiveness, repeat AF ablations (re-do procedures, RDP) are often required to maintain sinus rhythm.
Purpose
Determine predictors for multiple and/or complex RDP, evaluate reference values for procedure duration and radiation exposure during index PVI (iPVI) and nth RDP in a large cohort.
Methods and Results
Data mining identified 934 (mean age 62.6 ± 12.3 years, 346 females) out of 6848 total AF ablation patients from a large German AF ablation center between 09/2008 and 09/2021 with an index PVI and at least one RDP. Analysis included 2152 procedures (out of 8750 total AF-related ablations). At iPVI, AF pattern was classified as paroxysmal AF (PAF) in 387 patients (41%). All others (59%) were classified as non-paroxysmal AF (Non-PAF). Non-PAF was significantly more frequent in males (64% vs. 49%, p<0.01). Median period between first PVI and RDP was 558 days (25th/75th percentiles 244.0/1175.5 days). Non-PAF patients had a significantly higher probability of multiple RDP compared to patients with PAF at iPVI (p<0.01, Figure 1A). 18% (8%) of patients with non-PAF had 2 (3) or more RDP while only 13% (3%) of pat. with PAF had 2 (3) or more RDP.
iPVI was classified as PVI-only or PVI with additional substrate modification (SM). 724/934 patients (78%) received PVI-only as initial procedure. Of these, 572 (79%) had only 1 RDP, 116 (16%) had 2 RDP and 36 (5%) had 3 or more RDP. This distribution was 77%, 15% and 8% for 1, 2 and 3 or more RDP for patients with complex PVI as iPVI.
An algorithm based on regular expressions classified all RDP as repeat PVI (Re-PVI) due to reconduction (PV reconduction), ablation of atrial tachycardia (AT) or SM, e. g. defragmentation of fractionated signals, or combinations. The results were manually quality-controlled. 798/934 (85%) patients required PV re-isolation due to PV reconduction, 298/934 (32%) required ablation for atrial tachycardia (AT) at least once during FU (Figure 1B). Comparing PVI-only iPVI patients with patients who received substrate modification during iPVI, significantly less patients with PVI-only iPVI had RDP for AT compared to those with SM during iPVI (27% vs. 50%, p<0.01). More PVI-only iPVI patients required PV-reisolation at any time during FU (87% vs 79%, p<0.01). Considering PVI-only (+/- CTI) iPVIs only, dose-area product decreased in RDP compared to first PVI, while procedure duration slightly increased (Figure 1C). Data on periprocedural complications will be reported.
Conclusion
Redo AF ablations procedures are mainly required due to reconnected pulmonary veins or AT. Patients with PAF at iPVI are less likely to require more than one RDP which provides indirect support for early rhythm control in treatment of AF. SM at iPVI might be a predictor for occurrence of AT in the further course.
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Affiliation(s)
- J Obergassel
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - S Taraba
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - M Nies
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - C Atzor
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - MD Lemoine
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - L Rottner
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - R Schleberger
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - LWH Dinshaw
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - C Meyer
- Evangelical Hospital, Cardiology, Duesseldorf, Germany
| | - S Willems
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - B Reissmann
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - F Ouyang
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - A Metzner
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - A Rillig
- University Heart & Vascular Center Hamburg, Hamburg, Germany
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40
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Kaiser L, Hochadel M, Senges J, Kleemann T, Szendey I, Voss F, Steinbeck G, Leschke M, Butter C, Becker R, Willems S, Hakmi S. Procedure related complications following implantation of cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) devices - Insights from the German DEVICE registry. Europace 2022. [DOI: 10.1093/europace/euac053.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Stiftung Institut für Herzinfarktforschung
Background
The number of patients receiving cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) devices has been increasing in the last decades. Both CRT and ICD play an essential role in modern heart failure therapy. However, the implantation procedure might be ensued by serious complications. Therefore, knowledge about the prevalence of complications and identification of risk factors are key to improve patient care.
Methods
Between 2007-2014 the German DEVICE registry enrolled patients from 50 German centers undergoing ICD or CRT implantation. Patient characteristics, data on procedural outcome, adverse events and mortality during index hospitalization and follow-up at 1 year from discharge, were recorded. Patients who suffered from perioperative complications during or shortly after device implantation were identified for comparative analysis with patients without complications.
Results
Out of 4170 patients enrolled, 119 (2.9%) suffered from procedure related complications. The proportion of female patients suffering from perioperative complications was higher with 29.4%, compared to 18.5% of female patients without complications (p=0.003). There were neither any differences in age (66.3±13.6 vs. 65.4±12.5 years; p=0.13), nor in cardiac or non-cardiac comorbidities and in the indications for device implantation between groups. There was a trend towards a higher rate of complications with procedures on pre-existing devices (24,8 vs. 18.1%; p=0.064), than observed with de-novo implantations (75.2 vs. 81.9%; p=0.064). CRT implantations were more frequent among patients who suffered from complications (46.2 vs. 28.9%; p<0.001), compared to the group without complications, in which the proportion of ICD implantations was much more frequent (53.8 vs. 71.1%; p<0.001). The most frequent complication overall was pocket hematoma (55.1%), followed by pneumothorax (30.3%), pericardial effusion/tamponade (12.7%) and haemothorax (4.2%). The median hospital stay was significantly longer for patients with complications (7 [5; 11] vs. 3 [2; 5] days; p<0.001)). There was no difference in all-cause in-hospital mortality between respective groups. Median follow-up was 455 [398; 551] vs. 462 [391; 569] days (p=0.82) with no differences in all-cause mortality (6.5 vs. 6.9%; p=0.88), device-associated complications (12.6 vs. 8.5%; p=0.18) or rehospitalizations (37.9 vs. 32.2%; p=0.26) after 1-year follow-up.
Conclusion
The overall procedure-related complication rate following CRT or ICD implantation is low (2.9%). Among patients with complications female gender and patients receiving CRT devices were more prevalent. Perioperative device complications neither seem to translate into increased in-hospital mortality, nor in increased rates of further device-associated complications, rehospitalizations or death after 1-year follow-up.
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Affiliation(s)
- L Kaiser
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - M Hochadel
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - J Senges
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - T Kleemann
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - I Szendey
- Krankenhaus St. Franziskus, Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
| | - F Voss
- Hospital Barmherzigen Bruder Trier, Trier, Germany
| | - G Steinbeck
- Klinikum Starnberg, Zentrum fuer Kardiologie, Starnberg, Germany
| | - M Leschke
- Clinic Esslingen, Esslingen, Germany
| | - C Butter
- Brandenburg Heart Center, Bernau bei Berlin, Germany
| | - R Becker
- Clinic Wolfsburg, Wolfsburg, Germany
| | - S Willems
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - S Hakmi
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
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Chung D, Burger H, Kaiser L, Osswald B, Baersch V, Naegele H, Knaut M, Reichenspurner H, Willems S, Butter C, Pecha S, Hakmi S. Procedural outcome and risk prediction in patients with implantable cardioverter-defibrillator (ICD) undergoing transvenous lead extraction: a GALLERY subgroup analysis. Europace 2022. [DOI: 10.1093/europace/euac053.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Device complications, such as infection or lead dysfunction necessitating transvenous lead extraction (TLE) are continuously rising amongst patients with indwelling transvenous implantable cardioverter-defibrillator (ICD).
Objectives
Aim of this study was to characterize the procedural outcome and risk factors of patients with indwelling 1- and 2-chamber ICD undergoing TLE.
Methods
We conducted a subgroup analysis of all 1- and 2-chamber ICD patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) database. Predictors for procedural failure and all-cause mortality were assessed.
Results
A total of 854 patients with ICD undergoing TLE were identified, who were younger (62.9±13.8 vs. 70.7±13.0 years; p<0.001), less likely to be female (20.8 vs. 27.1%; p<0.001) and had a higher proportion of patients with coronary artery disease (51.5 vs. 38.6%; p<0.001) and highly reduced ejection fraction (32.0 vs. 23.0%; p>0.001), when compared to non-ICD patients. Leading extraction indication was lead dysfunction (48.0 vs. 21.9%; p<0.001), followed by device-related infection (45.6 vs. 73.0%; p<0.001). There were no differences in overall procedural complications (4.3 vs. 4.3%; p=0.980), clinical success rate (97.9 vs. 97.8%; p=0.861) or procedure-related (0.8 vs. 0.5%; p=0.292) and all-cause mortality (3.4 vs. 3.7%; 0.742) between groups. Multivariate analysis revealed lead age≥10 years (OR:5.75, 95%CI:2.0-16.2; p=0.001) as independent predictor for procedural failure. Systemic infection as extraction indication (OR:9.57, 95%CI:2.2-42.4; p=0.003) and procedural complications (OR:8.0, 95%CI:2.8-23.3; p<0.001) were identified as risk factors for all-cause mortality. Predictors for systemic infection in ICD patients were atrial fibrillation (OR: 2.22, 95%CI: 1.51-3.27; p<0.001), diabetes mellitus (OR: 2.28, 95%CI: 1.59-3.25; p<0.001) and chronic kidney disease (OR: 2.0, 95%CI: 1.39-2.89; p<0.001).
Conclusions
Transvenous lead extraction is safe and efficacious in patients with 1- and 2-chamber ICD. Although lead dysfunction is the leading indication for extraction, systemic device-related infection is the main driver of all-cause mortality for ICD patients undergoing TLE.
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Affiliation(s)
- D Chung
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - H Burger
- Kerckhoff Clinic, Cardiac Surgery, Bad Nauheim, Germany
| | - L Kaiser
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - B Osswald
- Johanniter Hospital Duisburg Rheinhausen, Division of Electrophysiological Surgery, Duisburg, Germany
| | - V Baersch
- St. Marien-Hospital Siegen, Cardiology, Siegen, Germany
| | - H Naegele
- Albertinen Hospital, Cardiology, Hamburg, Germany
| | - M Knaut
- Dresden University Heart Center, Cardiology, Dresden, Germany
| | - H Reichenspurner
- University Heart Center Hamburg, Cardiovascular Surgery, Hamburg, Germany
| | - S Willems
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - C Butter
- Brandenburg Heart Center, Cardiology, Bernau bei Berlin, Germany
| | - S Pecha
- University Heart Center Hamburg, Cardiovascular Surgery, Hamburg, Germany
| | - S Hakmi
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
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Chung D, Hochadel M, Senges J, Kleemann T, Eckhardt L, Brachmann J, Steinbeck G, Larbig R, Butter C, Schulz E, Willems S, Hakmi S. Implantable cardioverter-defibrillator therapy in the very young - Patient characteristics procedural outcome and one-year follow-up - A subgroup analysis of the german DEVICE registry. Europace 2022. [DOI: 10.1093/europace/euac053.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) are well-established and essential therapeutic pillars for patients with heart failure and survivors of sudden cardiac death. The number of young patients receiving ICD or CRT-D has been increasing in the last decades. Understanding the key differences between the typically older ICD population and younger patients is paramount to optimized patient care.
Methods
The DEVICE registry prospectively enrolled patients undergoing ICD/CRT implantation or revision from 50 German centers between 2007–2014. Data on patient characteristics, procedural outcome, adverse events and mortality during the initial stay and follow-up was collected. All patients under the age of 45 years were identified and included into a comparative analysis with the remaining population.
Results
A total number of 4181 patients were enrolled into the registry, of which 236 patients (5.6%) were under the age of 45 years. Median age was 38.0 [31.0; 42.0] vs. 69.0 [60.0; 75.0] years, p<0.001), compared to older patients. Young patients were more likely to receive an ICD (91.5 vs. 69.4%, p<0.001), than CRT device and were less likely to suffer from non-cardiac comorbidities (20.3 vs. 67.4%, p<0.001). Coronary artery disease was less common in young patients (15.7 vs. 63.6%, p<0.001), whereas hypertrophic cardiomyopathy (11.0 vs. 2.5%, p<0.001) and primary cardiac electrical diseases (14.0 vs. 1.6%, p< 0.001) were encountered more often. Mean left-ventricular ejection fractions were 42.4±18.5 vs. 31.5±11.8%, respectively (p<0.001) with less young patients in NYHA functional class III/IV (19.5 vs. 45.3%, p<0.001). Primary symptom at presentation was chronic heart failure for older patients (19.5 vs. 34.8%, p<0.001) and survived sudden cardiac death (30.9 vs. 15.6%, p<0.001) for young patients. Thus, ICD for secondary prevention was more common in young patients (53.8 vs. 43.2%, p<0.001). There were no detectable differences in postoperative complications (3.0 vs. 4.1%, p=0.500) or in-hospital mortality (0.0 vs. 0.3%, p=1.000). Median follow-up time was 514 [398; 669] vs. 458 [391; 563] days (p=0.006). Device-associated complications requiring revision were more common in young patients (16.3 vs. 8.2%, p<0.001) and all-cause 1-year-mortality after implantation was lower (3.1 vs. 7.3%, p=0.029; HR 0.42, 95%CI: 0.19-0.94). Even though there was no difference in rates of rehospitalization between groups (32.1 vs. 32.4%, p=0.93), young patients were re-admitted more often for "cardiac" reasons (82.7 vs. 58.9%, p<0.001).
Conclusion
Rates for procedural complications and in-hospital mortality were very low and without differences between both age groups. However younger patients experienced a higher rate of postoperative complications requiring revision and had higher readmission rates for cardiac reasons, potentially due to a more active lifestyle.
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Affiliation(s)
- D Chung
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - M Hochadel
- IHF GmbH Institute for Heart Attack Research, Ludwigshafen, Germany
| | - J Senges
- IHF GmbH Institute for Heart Attack Research, Ludwigshafen, Germany
| | - T Kleemann
- Klinikum Ludwigshafen, Cardiology, Ludwigshafen, Germany
| | - L Eckhardt
- Muenster University Hospital, Cardiac Electrophysiology, Muenster, Germany
| | - J Brachmann
- Cardiac Center of Coburg, RegioMed Medical School, Coburg, Germany
| | | | - R Larbig
- Kliniken Maria Hilf Moenchengladbach, Cardiology, Moenchengladbach, Germany
| | - C Butter
- Brandenburg Heart Center, Cardiology, Bernau bei Berlin, Germany
| | - E Schulz
- General Hospital of Celle, Cardiology, Celle, Germany
| | - S Willems
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - S Hakmi
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
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Kahle AK, Klatt N, Jungen C, Dietenberger A, Kuklik P, Muenkler P, Willems S, Nikolaev V, Scherschel K, Meyer C. Selective intracardiac sympathetic denervation acutely modulates left ventricular control. Europace 2022. [DOI: 10.1093/europace/euac053.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Centre for Cardiovascular Research (DZHK)
Background
The sympathetic nervous system plays an integral role in cardiac physiology. Neuromodulation is emerging as a treatment option for ventricular arrhythmias, but selective intracardiac approaches are rare. Sympathetic nerve fibers innervating the left ventricle have been demonstrated to be amenable to transvenous catheter stimulation along the coronary sinus (CS).
Purpose
The aim of the present study was to modulate left ventricular control by selective sympathetic denervation using epicardial or standard catheter ablation for intracardiac axotomy at the level of the CS.
Methods
First, the impact of epicardial CS ablation on cardiac electrophysiology was studied in a Langendorff model of murine hearts (n=10 each, ablation and control). Second, the impact of transvenous, anatomically-driven axotomy by catheter-based radiofrequency ablation along the CS was evaluated in a healthy ovine in vivo model (n=8) before and during left stellate ganglion stimulation (LSGS).
Results
CS ablation for intracardiac sympathetic axotomy prolonged epicardial ventricular refractory period (VRP) without (41.8±8.4 ms vs. 53.0±13.5 ms; P=0.0487) and with beta1-2-adrenergic receptor blockade (47.8±2.8 ms vs. 73.1±5.0 ms; P=0.0009) and enhanced the increasing effect of beta1-2-adrenergic receptor blockade on epicardial VRP (∆VRP 6.3±7.0 ms vs. 20.0±7.5 ms; P=0.0045) in mice (Figure, A). Mean epicardial wave propagation velocity in the left ventricle was faster in ablated hearts than in controls (1.13±0.05 m/s vs. 1.00±0.02 m/s; P=0.0463), but did not differ in the right ventricle (1.15±0.05 m/s vs. 1.20±0.08 m/s; P=0.7938). Transvenous catheter ablation of the CS reduced systolic (SBP, 57.7±5.0 mmHg vs. 46.9±3.6 mmHg; P=0.0428) and diastolic blood pressure (DBP, 35.5±3.0 mmHg vs. 26.7±1.8 mmHg; P=0.0106) and diminished the blood pressure increase during LSGS in sheep (∆SBP 21.9±3.8 mmHg vs. 10.5±4.2 mmHg; P=0.0234; ∆DBP 9.0±1.9 mmHg vs. 3.0±1.2 mmHg; P=0.0391) (Figure, B, C). Cycle length remained unchanged by LSGS, both before (baseline 653.2±20.6 ms vs. LSGS 627.8±27.5 ms; P=0.2309) and after CS ablation (baseline 734.8±24.2 ms vs. LSGS 746.2±37.3 ms; P=0.7145).
Conclusions
Anatomically-driven axotomy targeting nerve fibers along the CS enables selective intracardiac sympathetic denervation resulting in acute modulation of left ventricular control.
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Affiliation(s)
- AK Kahle
- Evangelical Hospital, Duesseldorf, Germany
| | - N Klatt
- Schoen Clinic Neustadt, Neustadt in Holstein, Germany
| | - C Jungen
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - A Dietenberger
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - P Kuklik
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - P Muenkler
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - S Willems
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - V Nikolaev
- University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | | | - C Meyer
- Evangelical Hospital, Duesseldorf, Germany
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Murray R, Cristobal F, Shrestha S, Tandinco FD, De Maeseneer JM, Verma S, Dharamsi S, Willems S, Kaufman A, Pálsdóttir B, Neusy AJ, Larkins S. COVID-19 fosters social accountability in medical education. Rural Remote Health 2022; 22:6998. [PMID: 35538625 DOI: 10.22605/rrh6998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The COVID-19 pandemic has highlighted embedded inequities and fragmentation in our health systems. Traditionally, structural issues with health professional education perpetuate these. COVID-19 has highlighted inequities, but may also be a disruptor, allowing positive responses and system redesign. Examples from health professional schools in high and low- and middle-income countries illustrate pro-equity interventions of current relevance. We recommend that health professional schools and planners consider educational redesign to produce a health workforce well equipped to respond to pandemics and meet future need.
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Affiliation(s)
- Richard Murray
- Division of Health and Medicine, James Cook University, Douglas, Qld 4811, Australia
| | | | | | - Filedito D Tandinco
- School of Health Sciences, University of the Philippines, Manila, Palo, Leyte, Philippines
| | - Jan M De Maeseneer
- WHO Collaborating Centre on Family Medicine and Primary Health Care; and Department of Public Health and Primary Care, Gent University, Corneel Heymanslaan, B-9000 Gent, Belgium
| | - Sarita Verma
- Northern Ontario School of Medicine, Thunder Bay, Ontario P7B 5E1, Canada
| | | | - Sara Willems
- Department of Public Health and Primary Care, Gent University, Corneel Heymanslaan, B-9000 Gent, Belgium
| | - Arthur Kaufman
- School of Medicine, University of New Mexico, MSC09 5040, Albuquerque, NM 87131, USA
| | - Björg Pálsdóttir
- Training for Health Equity Network (THEnet), 142 West 73rd Street, New York City, NY 10023, USA
| | - Andre-Jacques Neusy
- Training for Health Equity Network (THEnet), 142 West 73rd Street, New York City, NY 10023, USA
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Douglas, Qld 4811, Australia
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Marchi M, Magarini FM, Chiarenza A, Galeazzi GM, Paloma V, Garrido R, Ioannidi E, Vassilikou K, de Matos MG, Gaspar T, Guedes FB, Primdahl NL, Skovdal M, Murphy R, Durbeej N, Osman F, Watters C, van den Muijsenbergh M, Sturm G, Oulahal R, Padilla B, Willems S, Spiritus-Beerden E, Verelst A, Derluyn I. Experience of discrimination during COVID-19 pandemic: the impact of public health measures and psychological distress among refugees and other migrants in Europe. BMC Public Health 2022; 22:942. [PMID: 35538463 PMCID: PMC9090600 DOI: 10.1186/s12889-022-13370-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background The COVID-19 pandemic has had a disproportionately hard impact on refugees and other migrants who are often exposed to the virus with limited means to protect themselves. We tested the hypothesis that during the COVID-19 pandemic, refugees and other migrants have suffered a negative impact on mental health and have been unjustly discriminated for spreading the disease in Europe (data collection from April to November 2020). Methods Participants in the ApartTogether Survey (N = 8297, after listwise deletion of missing items final N = 3940) provided data regarding to their difficulties to adhere to preventive recommendations against COVID-19 infection (CARE), self-perceived stigmatization (SS), and psychological distress (PD). Structural Equation Modeling was used to investigate PD as a mediator in the pathway linking CARE to SS, while adjusting for the housing and residence status. To improve confidence in the findings, single hold-out sample cross-validation was performed using a train/test split ratio of 0.8/0.2. Results In the exploratory set (N = 3159) SS was associated with both CARE (B = 0.200, p < 0.001) and PD (B = 0.455, p < 0.001). Moreover, PD was also associated with CARE (B = 0.094, p = 0.001) and mediated the effect of CARE on SS (proportion mediated = 17.7%, p = 0.001). The results were successfully replicated in the confirmation set (N = 781; total effect = 0.417, p < 0.001; proportion mediated = 29.7%, p < 0.001). Follow-up analyses also found evidence for an opposite effect (i.e., from SS to CARE, B = 0.132; p < 0.001), suggesting that there might be a vicious circle between the self-perceived stigmatization and the access to health care and the use of preventive measures against COVID-19 infection. Conclusions Refugees and other migrants who had more difficulties in accessing health care and preventive measures against COVID-19 infection experienced worse mental health and increased discrimination. These negative effects appeared to be stronger for those with more insecure housing and residence status, highlighting from one side the specific risk of insecure housing in the impact of COVID-19 upon mental health and infection protection, and for another side the need to proper housing as a strategy to prevent both COVID-19 and mental distress. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13370-y.
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Affiliation(s)
- Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287 -, 41125, Modena, Italy.,Dipartimento di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2 -, 42122, Reggio Emilia, Italy
| | - Federica Maria Magarini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287 -, 41125, Modena, Italy
| | - Antonio Chiarenza
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287 -, 41125, Modena, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287 -, 41125, Modena, Italy. .,Dipartimento di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2 -, 42122, Reggio Emilia, Italy.
| | - Virginia Paloma
- Department of Social Psychology, Universidad de Sevilla, 41018, Seville, Spain
| | - Rocío Garrido
- Department of Social Psychology, Universidad de Sevilla, 41018, Seville, Spain
| | - Elisabeth Ioannidi
- Research Center for Greek Society, Academy of Athens, 15126, Athens, Greece
| | | | | | - Tania Gaspar
- Institute of Environmental Health/ISAMB, University of Lisbon, Lisbon, Portugal
| | | | - Nina Langer Primdahl
- Department of Public Health, University of Copenhagen, 1014, Copenhagen, Denmark
| | - Morten Skovdal
- Department of Public Health, University of Copenhagen, 1014, Copenhagen, Denmark
| | - Rebecca Murphy
- Department of Psychology, Maynooth University, W23 F2K8, Co. Kildare, Maynooth, Ireland
| | - Natalie Durbeej
- Department of Child Health and Parenting, Uppsala University, 75236, Uppsala, Sweden
| | - Fatumo Osman
- Department of Child Health and Parenting, Uppsala University, 75236, Uppsala, Sweden.,School of Health and Welfare, Dalarna University, Högskolegatan 2, 79188, Falun, Sweden
| | - Charles Watters
- Department of School of Education and Social Work, University of Sussex, Sussex, UK
| | | | - Gesine Sturm
- LCPI Laboratory, EA-4591, Department Clinique du Sujet, University of Toulouse 2, 31058, Toulouse, France
| | - Rachid Oulahal
- La Reunion University FR, DIRE research center, French Collaborative Institute on Migration, CS, 92003, 15 Av. René Cassin, Saint-Denis, Cedex 9 97400, Réunion
| | - Beatriz Padilla
- Department of Sociology, University of South Florida, Tampa, FL, 33620, USA
| | - Sara Willems
- Department of Public Health and Primary Care, Quality and Safety Ghent, Ghent University, 9000, Ghent, Belgium
| | - Eva Spiritus-Beerden
- Department of Social Work and Social Pedagogy, Ghent University, 9000, Ghent, Belgium
| | - An Verelst
- Department of Social Work and Social Pedagogy, Ghent University, 9000, Ghent, Belgium
| | - Ilse Derluyn
- Department of Social Work and Social Pedagogy, Ghent University, 9000, Ghent, Belgium
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Collins C, Clays E, Van Poel E, Cholewa J, Tripkovic K, Nessler K, de Rouffignac S, Šantrić Milićević M, Bukumiric Z, Adler L, Ponsar C, Murauskiene L, Ožvačić Adžić Z, Windak A, Asenova R, Willems S. Distress and Wellbeing among General Practitioners in 33 Countries during COVID-19: Results from the Cross-Sectional PRICOV-19 Study to Inform Health System Interventions. Int J Environ Res Public Health 2022; 19:5675. [PMID: 35565070 PMCID: PMC9101443 DOI: 10.3390/ijerph19095675] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022]
Abstract
Emerging literature is highlighting the huge toll of the COVID-19 pandemic on frontline health workers. However, prior to the crisis, the wellbeing of this group was already of concern. The aim of this paper is to describe the frequency of distress and wellbeing, measured by the expanded 9-item Mayo Clinic Wellbeing Index (eWBI), among general practitioners/family physicians during the COVID-19 pandemic and to identify levers to mitigate the risk of distress. Data were collected by means of an online self-reported questionnaire among GP practices. Statistical analysis was performed using SPSS software using Version 7 of the database, which consisted of the cleaned data of 33 countries available as of 3 November 2021. Data from 3711 respondents were included. eWBI scores ranged from -2 to 9, with a median of 3. Using a cutoff of ≥2, 64.5% of respondents were considered at risk of distress. GPs with less experience, in smaller practices, and with more vulnerable patient populations were at a higher risk of distress. Significant differences in wellbeing scores were noted between countries. Collaboration from other practices and perception of having adequate governmental support were significant protective factors for distress. It is necessary to address practice- and system-level organizational factors in order to enhance wellbeing and support primary care physicians.
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Affiliation(s)
- Claire Collins
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
| | - Els Clays
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium; (E.C.); (E.V.P.); (S.W.)
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium; (E.C.); (E.V.P.); (S.W.)
| | - Joanna Cholewa
- Institute of Health and Society, Catholic University of Louvain, 1348 Louvain-la-Neuve, Belgium; (J.C.); (S.d.R.); (C.P.)
| | - Katica Tripkovic
- City Institute of Public Health Belgrade, 11000 Belgrade, Serbia;
| | - Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, 31-061 Krakow, Poland; (K.N.); (A.W.)
| | - Ségolène de Rouffignac
- Institute of Health and Society, Catholic University of Louvain, 1348 Louvain-la-Neuve, Belgium; (J.C.); (S.d.R.); (C.P.)
| | | | - Zoran Bukumiric
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.Š.M.); (Z.B.)
| | - Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Cécile Ponsar
- Institute of Health and Society, Catholic University of Louvain, 1348 Louvain-la-Neuve, Belgium; (J.C.); (S.d.R.); (C.P.)
| | - Liubove Murauskiene
- Public Health Department, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania;
| | - Zlata Ožvačić Adžić
- Department of Family Medicine, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, 31-061 Krakow, Poland; (K.N.); (A.W.)
| | - Radost Asenova
- Department of General Practice, Medical University Plovdiv, 4003 Plovdiv, Bulgaria;
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium; (E.C.); (E.V.P.); (S.W.)
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47
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Groenewegen P, van den Muijsenbergh M, Batenburg R, Van Poel E, van den Broek S, Bussche PV, Willems S. Snelle aanpassing praktijkorganisatie tijdens de coronapandemie. Huisarts Wet 2022; 65:16-20. [PMID: 35400733 PMCID: PMC8976212 DOI: 10.1007/s12445-022-1439-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Huisartsenpraktijken pasten tijdens de coronapandemie hun organisatie aan, mede op basis van informatie en adviezen van hun beroepsorganisaties. De aanpassingen waren noodzake-lijk om de zorg voor patiënten zo veel en zo veilig mogelijk doorgang te laten vinden, vaak op afstand. De pandemie zelf, de zorg op afstand en de strakkere geleiding van de patiëntenstroom zetten de kwaliteit van zorg en de patiëntveiligheid onder druk. De toegankelijkheid van de praktijken was soms beperkt, in de beleving van patiënten was dat sterker dan in werkelijkheid.
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Affiliation(s)
- Peter Groenewegen
- Senior onderzoeker zorgstelsel en sturing, Nivel, Utrecht, Nederland
| | - Maria van den Muijsenbergh
- Huisarts, hoogleraar gezondheidsverschillen en persoonsgerichte geïntegreerde eerstelijnszorg, Radboudumc, European Forum for Primary Care, Nijmegen, Nederland
| | - Ronald Batenburg
- Programmaleider arbeids- en organisatievraagstukken in de gezondheidszorg (tevens Radboudumc), Nivel, Utrecht, Nederland
| | - Esther Van Poel
- Promovenda, Universiteit Gent, Vakgroep Volksgezondheid en Eerstelijnszorg, Quality and Safety Ghent, Ghent, Nederland
| | - Stijn van den Broek
- Kaderhuisarts, senior stafmedewerker beleid & organisatie huisartsenzorg (tevens EQuiP), NHG, Utrecht, Nederland
| | - Pierre Vanden Bussche
- Huisarts en expert implementatiestrategieën, naadloze zorg, veilige zorg, Ghent, Nederland
| | - Sara Willems
- Voorzitter Quality and Safety Ghent, Ghent, Nederland
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48
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Bollen H, Nuyts S, Willems S, Maes F. MO-0886 Automatic delineation of head and neck gross tumor volume using multimodal information. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02452-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schelfhout S, Vandecasteele R, De Maesschalck S, D’hondt F, Willems S, Derous E. Intercultural Competence Predicts Intercultural Effectiveness: Test of an Integrative Framework. IJERPH 2022; 19:ijerph19084490. [PMID: 35457357 PMCID: PMC9026297 DOI: 10.3390/ijerph19084490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/21/2022] [Accepted: 04/01/2022] [Indexed: 11/26/2022]
Abstract
Why does someone thrive in intercultural situations; while others seem to struggle? In 2014, Leung and colleagues summarized the literature on intercultural competence and intercultural effectiveness into a theoretical framework. This integrative framework hypothesizes that the interrelations between intercultural traits, intercultural attitudes and worldviews, and intercultural capabilities predict the effectiveness with which individuals respond to intercultural situations. An empirically verified framework can contribute to understanding intercultural competence and effectiveness in health care workers, thus contributing to more equity in health care. The present study sets out to test this integrative framework in a specific health care context. Future health care practitioners (N = 842) in Flanders (Belgium) were questioned on all multidimensional components of the framework. Structural equation modeling showed that our data were adequate to even a good fit with the theoretical framework, while providing at least partial evidence for all hypothesized relations. Results further showed that intercultural capabilities remain the major gateway toward more effective intercultural behavior. Especially the motivation and cognition dimensions of cultural intelligence seem to be key factors, making these dimensions an excellent target for training, practical interventions, and identifying best practices, ultimately supporting greater intercultural effectiveness and more equity in health care.
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Affiliation(s)
- Stijn Schelfhout
- Research Group Vocational and Personnel Psychology, Department of Work, Organisation and Society, Faculty of Psychology and Educational Sciences, Ghent University, H. Dunantlaan 2, 9000 Ghent, Belgium;
- Department of Experimental Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
- Interdepartmental Research Group Vocational and Personnel Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
- Correspondence:
| | - Robin Vandecasteele
- Research Group Equity in Health Care, Quality & Safety, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, University Hospital Campus Entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium; (R.V.); (S.D.M.); (S.W.)
| | - Stéphanie De Maesschalck
- Research Group Equity in Health Care, Quality & Safety, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, University Hospital Campus Entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium; (R.V.); (S.D.M.); (S.W.)
| | - Fanny D’hondt
- Department of Sociology, Faculty of Political and Social Sciences, Ghent University, Sint-Pietersnieuwstraat 41, 9000 Ghent, Belgium;
| | - Sara Willems
- Research Group Equity in Health Care, Quality & Safety, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, University Hospital Campus Entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium; (R.V.); (S.D.M.); (S.W.)
- Centre for the Social Study of Migration and Refugees, Ghent University, H. Dunantlaan 2, 9000 Ghent, Belgium
| | - Eva Derous
- Research Group Vocational and Personnel Psychology, Department of Work, Organisation and Society, Faculty of Psychology and Educational Sciences, Ghent University, H. Dunantlaan 2, 9000 Ghent, Belgium;
- Interdepartmental Research Group Vocational and Personnel Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
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Silva B, Hens N, Gusso G, Lagaert S, Macinko J, Willems S. Dual Use of Public and Private Health Care Services in Brazil. IJERPH 2022; 19:ijerph19031829. [PMID: 35162852 PMCID: PMC8835064 DOI: 10.3390/ijerph19031829] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 12/04/2022]
Abstract
(1) Background: Brazil has a universal public healthcare system, but individuals can still opt to buy private health insurance and/or pay out-of-pocket for healthcare. Past research suggests that Brazilians make combined use of public and private services, possibly causing double costs. This study aims to describe this dual use and assess its relationship with socioeconomic status (SES). (2) Methods: We calculated survey-weighted population estimates and descriptive statistics, and built a survey-weighted logistic regression model to explore the effect of SES on dual use of healthcare, including demographic characteristics and other variables related to healthcare need and use as additional explanatory variables using data from the 2019 Brazilian National Health Survey. (3) Results: An estimated 39,039,016 (n = 46,914; 18.6%) persons sought care in the two weeks before the survey, of which 5,576,216 were dual users (n = 6484; 14.7%). Dual use happened both in the direction of public to private (n = 4628; 67.3%), and of private to public (n = 1855; 32.7%). Higher income had a significant effect on dual use (p < 0.0001), suggesting a dose–response relationship, even after controlling for confounders. Significant effects were also found for region (p < 0.0001) and usual source of care (USC) (p < 0.0001). (4) Conclusion: A large number of Brazilians are seeking care from a source different than their regular system. Higher SES, region, and USC are associated factors, possibly leading to more health inequity. Due to its high prevalence and important implications, more research is warranted to illuminate the main causes of dual use.
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Affiliation(s)
- Bianca Silva
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, BE-9000 Ghent, Belgium; (S.L.); (S.W.)
- Correspondence:
| | - Niel Hens
- Data Science Institute (DSI), I-BioStat, Hasselt University, BE-3500 Hasselt, Belgium;
| | - Gustavo Gusso
- Faculty of Medicine, University of São Paulo, São Paulo 05403-000, Brazil;
| | - Susan Lagaert
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, BE-9000 Ghent, Belgium; (S.L.); (S.W.)
| | - James Macinko
- Department of Health Policy and Management, University of California Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, CA 90095, USA;
| | - Sara Willems
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, BE-9000 Ghent, Belgium; (S.L.); (S.W.)
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