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Shabani Isenaj Z, Berisha M, Ukëhaxhaj A, Moshammer H. Particulate Air Pollution and Primary Care Visits in Kosovo: A Time-Series Approach. Int J Environ Res Public Health 2022; 19:16591. [PMID: 36554471 PMCID: PMC9779424 DOI: 10.3390/ijerph192416591] [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] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
This study aimed to investigate the effects of particulate air pollution (PM2.5) on cardiovascular and respiratory diseases in Pristina, Kosovo, in a time-series analysis using daily primary healthcare visits to primary care institutions from 2019 to 2022. For the observation period, 6440 cardiovascular and 15,141 respiratory visits were reported, whereas the daily mean concentrations of PM2.5 ranged between 2.41 and 120.3 µg/m3. Single-lag models indicated a bi-phasic lag structure with increasing effect estimates some days after the air pollution event. In the distributed lag model with seven lags, the effect estimates for the cardiovascular cases indicated the adverse effect of air pollution. The cumulative effect estimate (summed over lag 0 to 6) for an increase of 10 µg/m3 of PM2.5 was a relative risk of 1.010 (95% confidence interval: 1.001-1.019). For respiratory cases, a different lag model (lag 4 through 10) was additionally examined. In this model, significant increases in visits were observed on lags 7 and 8. Overall, no relevant increase in visits occurred during the seven days considered. Visits to general practitioners will often not occur immediately at disease onset because patients will wait, hoping that their health status improves spontaneously. Therefore, we expected some latency in the effects.
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Affiliation(s)
- Zana Shabani Isenaj
- Medical Faculty, University of Hasan Prishtina, Rr. George Bush Nr. 31, 10000 Pristina, Kosovo
- National Institute of Public Health, St. Mother Teresa pn, Rrethi i Spitalit, 10000 Pristina, Kosovo
| | - Merita Berisha
- Medical Faculty, University of Hasan Prishtina, Rr. George Bush Nr. 31, 10000 Pristina, Kosovo
- National Institute of Public Health, St. Mother Teresa pn, Rrethi i Spitalit, 10000 Pristina, Kosovo
| | - Antigona Ukëhaxhaj
- National Institute of Public Health, St. Mother Teresa pn, Rrethi i Spitalit, 10000 Pristina, Kosovo
- Master Programme, Medical Faculty, University Fehmi Agani, Rr. Ismail Qemali n.n., 50000 Gjakova, Kosovo
| | - Hanns Moshammer
- Department of Environmental Health, ZPH, Medical University of Vienna, 1090 Vienna, Austria
- Department of Hygiene, Medical University of Karakalpakstan, Nukus 230100, Uzbekistan
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Reges O, Feldhamer I, Wolff Sagy Y, Lavie G. Factors Associated with Using Telemedicine in the Primary Care Clinics during the COVID-19 Pandemic in Israel. Int J Environ Res Public Health 2022; 19:13207. [PMID: 36293788 PMCID: PMC9603207 DOI: 10.3390/ijerph192013207] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/02/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The COVID-19 pandemic generated an extraordinary need for telemedicine. OBJECTIVE To identify the factors and multi-way interactions associated with telemedicine use in primary healthcare during the COVID-19 pandemic. METHODS This population-based study included all members (2,722,773) aged ≥18 years of the largest healthcare organization in Israel who used primary care clinic services between 1 March 2020 and 31 December 2021. Individuals were classified as telemedicine users (≥1 phone/video visits or asynchronous encounters) or non-telemedicine users (only in-person encounter/s). RESULTS Ethnicity was the most discriminative variable associated with telemedicine use, with 85% and 52% users among Jews and Arabs, respectively. Higher odds for telemedicine utilization were observed among women, residents of urban areas, those confined to home, individuals with high level of technology literacy, residents of the central area (in Jews only), young Jews, and older Arabs. Based on decision tree analysis, the segments of the population with the lowest telemedicine use were characterized by lower primary care needs and comorbidities, as well as low technology literacy. The proportion of telemedicine use in these groups was 56% and 27% in Jews and in Arabs, respectively. CONCLUSION A proactive intervention program should be applied among populations who are less likely to use telemedicine in the primary care clinics, including Arabs, Jews who live in the distant periphery, and individuals with low technology literacy.
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Affiliation(s)
- Orna Reges
- Department of Health System Management, Ariel University, Ariel 477625, Israel
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 6209804, Israel
| | - Ilan Feldhamer
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 6209804, Israel
| | - Yael Wolff Sagy
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 6209804, Israel
| | - Gil Lavie
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 6209804, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3200003, Israel
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Miron O, Wolff Sagy Y, Yaron S, Ramot N, Lavie G. Trends in the Volume and Types of Primary Care Visits during the Two Years of the COVID-19 Pandemic in Israel. Int J Environ Res Public Health 2022; 19:ijerph191710601. [PMID: 36078316 PMCID: PMC9518373 DOI: 10.3390/ijerph191710601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/14/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 05/08/2023]
Abstract
BACKGROUND The outbreak of the COVID-19 pandemic led to a decrease in primary health care in-person visits and a simultaneous increase in virtual encounters. OBJECTIVE To quantify the change in the total volume of primary care visits and mix of visit types during the two years of the pandemic in Israel. DESIGN Cross-sectional study. PARTICIPANTS All primary care visits by members of the largest healthcare organization in Israel, during three one-year periods: the pre-COVID-19 year (March 2019-February 2020), the first year of COVID-19 (March 2020-February 2021), and the second year of COVID-19 (March 2021-February 2022). MAIN MEASURES Total volume of primary care visits and mix of visit types. RESULTS More than 112 million primary care visits were included in the study. The total visit rate per 1000 members did not change significantly between the pre-COVID year (19) and the first COVID year (19.8), but was 21% higher in the second COVID-19 year (23). The rate of in-person visits per 1000 members decreased from 12.0 in the pre-COVID year to 7.7 in the first COVID year and then increased to 9.6 in the second. The rate of phone visits and asynchronous communication increased from 0.7 and 6.3, respectively, in the pre-COVID year, to 4.1 and 8, respectively, in the first COVID year, and remained unchanged in the second. There was substantial variation across age groups and sectors in the adoption of virtual platforms. CONCLUSIONS The rapid introduction of virtual encounters in primary care tended to displace in-person visits in the first year of the pandemic, but they appear to have been additive in the second. This transition should be monitored, with the goal of ensuring appropriate planning efforts and resource allocation to deal with the potential added burden on medical staff. Efforts should be invested in encouraging the use of virtual platforms in patient groups that currently underutilize it, such as minorities.
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Affiliation(s)
- Oren Miron
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 62098, Israel
- Health Policy and Management, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Yael Wolff Sagy
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 62098, Israel
| | - Shlomit Yaron
- Community Medical Services Division, Clalit Health Services, Tel Aviv 62098, Israel
| | - Noga Ramot
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 62098, Israel
| | - Gil Lavie
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 62098, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel
- Correspondence: ; Tel.: +972-52-558-2800
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Pathman DE. Changes in Rates and Content of Primary Care Visits Within an Evolving Health Care System. Ann Fam Med 2019; 17:482-484. [PMID: 31712284 PMCID: PMC6846270 DOI: 10.1370/afm.2477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Donald E Pathman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Rao A, Shi Z, Ray KN, Mehrotra A, Ganguli I. National Trends in Primary Care Visit Use and Practice Capabilities, 2008-2015. Ann Fam Med 2019; 17:538-544. [PMID: 31712292 PMCID: PMC6846275 DOI: 10.1370/afm.2474] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Recent evidence shows a national decline in primary care visit rates over the last decade. It is unclear how changes in practice-including the use and content of primary care visits-may have contributed. METHODS We analyzed nationally representative data of adult visits to primary care physicians (PCPs) and physician practice characteristics from 2007-2016 (National Ambulatory Medical Care Survey). United States census estimates were used to calculate visits per capita. Measures included visit rates per person year; visit duration; number of medications, diagnoses, and preventive services per visit; percentage of visits with scheduled follow-up; and percentage of physicians with practice capabilities including an electronic medical record (EMR). RESULTS Our weighted sample represented 3.2 billion visits (83,368 visits, unweighted). Visits per capita declined by 20% (-0.25 visits per person, 95% CI, -0.32 to -0.19) during this time, while visit duration increased by 2.4 minutes per visit (95% CI, 1.1-3.8). Per visit, PCPs addressed 0.30 more diagnoses (95% CI, 0.16-0.43) and 0.82 more medications (95% CI, 0.59-1.1), and provided 0.24 more preventive services (95% CI, 0.12-0.36). Visits with scheduled PCP followup declined by 6.0% (95% CI, -12.4 to 0.46), while PCPs reporting use of EMR increased by 44.3% (95% CI, 39.1-49.5) and those reporting use of secure messaging increased by 60.9% (95% CI, 27.5-94.3). CONCLUSION From 2008 to 2015, primary care visits were longer, addressed more issues per visit, and were less likely to have scheduled follow-up for certain patients and conditions. Meanwhile, more PCPs offered non-face-to-face care. The decline in primary care visit rates may be explained in part by PCPs offering more comprehensive in-person visits and using more non-face-to-face care.
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Affiliation(s)
- Aarti Rao
- Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Zhuo Shi
- Harvard Medical School, Boston, Massachusetts
| | - Kristin N Ray
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ateev Mehrotra
- Harvard Medical School, Boston, Massachusetts.,Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ishani Ganguli
- Harvard Medical School, Boston, Massachusetts .,Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
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Koenig CJ, Ho EY, Yadegar V, Tarn DM. Negotiating complementary and alternative medicine use in primary care visits with older patients. Patient Educ Couns 2012; 89:368-73. [PMID: 22483672 PMCID: PMC3630233 DOI: 10.1016/j.pec.2012.02.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [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: 06/28/2011] [Revised: 02/12/2012] [Accepted: 02/29/2012] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To empirically investigate the ways in which patients and providers discuss Complementary and Alternative Medicine (CAM) treatment in primary care visits. METHODS Audio recordings from visits between 256 adult patients aged 50 years and older and 28 primary care physicians were transcribed and analyzed using discourse analysis, an empirical sociolinguistic methodology focusing on how language is used to negotiate meaning. RESULTS Discussion about CAM occurred 128 times in 82 of 256 visits (32.0%). The most frequently discussed CAM modalities were non-vitamin, non-mineral supplements and massage. Three physician-patient interactions were analyzed turn-by-turn to demonstrate negotiations about CAM use. Patients raised CAM discussions to seek physician expertise about treatments, and physicians adopted a range of responses along a continuum that included encouragement, neutrality, and discouragement. Despite differential knowledge about CAM treatments, physicians helped patients assess the risks and benefits of CAM treatments and made recommendations based on patient preferences for treatment. CONCLUSION Regardless of a physician's stance or knowledge about CAM, she or he can help patients negotiate CAM treatment decisions. PRACTICE IMPLICATIONS Providers do not have to possess extensive knowledge about specific CAM treatments to have meaningful discussions with patients and to give patients a framework for evaluating CAM treatment use.
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Zhao Y, Sun P, Bernauer M. Comparing common reasons for inpatient and outpatient visits between commercially-insured duloxetine or pregabalin initiators with fibromyalgia. J Pain Res 2012; 5:443-51. [PMID: 23152695 PMCID: PMC3496526 DOI: 10.2147/jpr.s35649] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to examine the main reasons for inpatient or outpatient visits after initiating duloxetine or pregabalin. Methods Commercially insured patients with fibromyalgia and aged 18–64 years who initiated duloxetine or pregabalin in 2006 with 12-month continuous enrollment before and after initiation were identified. Duloxetine and pregabalin cohorts with similar demographics, pre-index clinical and economic characteristics, and pre-index treatment patterns were constructed via propensity scoring stratification. Reasons for inpatient admissions, physician office visits, outpatient hospital visits, emergency room visits, and primary or specialty care visits over the 12 months post-index period were examined and compared. Logistic regression was used to assess the contribution of duloxetine versus pregabalin initiation to the most common reasons for visits, controlling for cross-cohort differences. Results Per the study design, the duloxetine (n = 3711) and pregabalin (n = 4111) cohorts had similar demographics (mean age 51 years, 83% female) and health care costs over the 12-month pre-index period. Total health care costs during the 12-month post-index period were significantly lower for duloxetine patients than for pregabalin patients ($19,378 versus $27,045, P < 0.05). Eight of the 10 most common reasons for inpatient admissions and outpatient hospital (physician office, emergency room, primary or specialty care) visits were the same for both groups. Controlling for cross-cohort differences, duloxetine patients were less likely to be hospitalized due to an intervertebral disc disorder or major depressive disorder, to have a physician office visit due to nonspecific backache/other back/neck pain (NB/OB/NP) disorder, or to go to specialty care due to a soft tissue, NB/OP/NP, or intervertebral disc disorder. However, duloxetine patients were more likely to have a primary care visit due to a soft tissue disorder, essential hypertension, or other general symptoms. Conclusion Among similar commercially insured patients with fibromyalgia who initiated duloxetine or pregabalin, duloxetine patients had significantly lower health care costs over the 12-month post-index period. The leading reasons for inpatient or outpatient visits were also somewhat different.
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Affiliation(s)
- Yang Zhao
- Eli Lilly and Company, Indianapolis, IN, USA
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